HB 1941

CS

CHAMBER ACTION

1	The Health & Families Council recommends the following:
2
3	Council/Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to the licensure of health care providers;
7	creating pts. I, II, III, and IV of ch. 408, F.S.;
8	creating s. 408.801, F.S.; providing a popular name;
9	providing legislative findings and purpose; creating s.
10	408.802, F.S.; providing applicability; creating s.
11	408.803, F.S.; providing definitions; creating s. 408.804,
12	F.S.; requiring providers to have and display a license;
13	providing limitations; creating s. 408.805, F.S.;
14	establishing license fees; providing a method for
15	calculating annual adjustment of fees; creating s.
16	408.806, F.S.; providing a license application process;
17	requiring specified information to be included on the
18	application; requiring payment of late fees under certain
19	circumstances; requiring inspections; providing an
20	exception; authorizing the Agency for Health Care
21	Administration to establish procedures and rules for
22	electronic transmission of required information; creating
23	s. 408.807, F.S.; providing procedures for change of
24	ownership; requiring the transferor to notify the agency
25	in writing within a specified time period; providing for
26	duties and liability of the transferor; providing for
27	maintenance of records; creating s. 408.808, F.S.;
28	providing license categories and requirements therefor;
29	creating s. 408.809, F.S.; requiring background screening
30	of specified employees; providing for submission of proof
31	of compliance, under certain circumstances; providing
32	conditions for granting provisional and standard licenses;
33	providing an exception to screening requirements; creating
34	s. 408.810, F.S.; providing minimum licensure
35	requirements; providing procedures for discontinuance of
36	operation and surrender of license; requiring forwarding
37	of client records; requiring publication of a notice of
38	discontinuance of operation of a provider; providing
39	penalties; providing for statewide toll-free telephone
40	numbers for reporting complaints and abusive, neglectful,
41	and exploitative practices; requiring proof of legal right
42	to occupy property, proof of insurance, and proof of
43	financial viability, under certain circumstances;
44	requiring disclosure of information relating to financial
45	instability; providing a penalty; prohibiting the agency
46	from licensing a health care provider that does not have a
47	certificate of need or an exemption; creating s. 408.811,
48	F.S.; providing for inspections and investigations to
49	determine compliance; providing that inspection reports
50	are public records; requiring retention of records for a
51	specified period of time; creating s. 408.812, F.S.;
52	prohibiting certain unlicensed activity by a provider;
53	requiring unlicensed providers to cease activity;
54	providing penalties; requiring reporting of unlicensed
55	providers; creating s. 408.813, F.S.; authorizing the
56	agency to impose administrative fines; creating s.
57	408.814, F.S.; providing conditions for the agency to
58	impose a moratorium or emergency suspension on a provider;
59	requiring notice; creating s. 408.815, F.S.; providing
60	grounds for denial or revocation of a license or change-
61	of-ownership application; providing conditions to continue
62	operation; exempting renewal applications from provisions
63	requiring the agency to approve or deny an application
64	within a specified period of time, under certain
65	circumstances; creating s. 408.816, F.S.; authorizing the
66	agency to institute injunction proceedings, under certain
67	circumstances; creating s. 408.817, F.S.; providing basis
68	for review of administrative proceedings challenging
69	agency licensure enforcement action; creating s. 408.818,
70	F.S.; requiring fees and fines related to health care
71	licensing to be deposited into the Health Care Trust Fund;
72	creating s. 408.819, F.S.; authorizing the agency to adopt
73	rules; providing a timeframe for compliance; amending s.
74	112.0455, F.S.; providing applicability of licensure
75	requirements under pt. II of ch. 408, F.S., to drug-
76	testing laboratories; establishing fees for license
77	applications; amending ss. 381.0303 and 381.78, F.S.;
78	conforming cross references; amending ss. 383.301,
79	383.305, and 383.309, F.S.; providing applicability of
80	licensure requirements under pt. II of ch. 408, F.S., to
81	birth centers; repealing s. 383.304, F.S., relating to
82	licensure requirement for birth centers; amending s.
83	383.315, F.S.; revising a provision relating to birth
84	center consultation agreements; repealing s. 383.332,
85	F.S., relating to establishing, managing, or operating a
86	birth center without a license and penalties therefor;
87	amending s. 383.324, F.S.; conforming provisions relating
88	to inspections and investigations of birth centers to
89	changes made by the act; repealing s. 383.325, F.S.,
90	relating to inspection reports; amending s. 383.33, F.S.,
91	relating to administrative fines, penalties, emergency
92	orders , and moratoriums on admissions; conforming
93	provisions to changes made by the act; repealing s.
94	383.331, F.S., relating to injunctive relief; amending s.
95	383.335, F.S., relating to partial exemptions; conforming
96	provisions to changes made by the act; amending s. 383.50,
97	F.S.; conforming a cross reference; amending s. 390.011,
98	F.S.; revising a definition; amending s. 390.012, F.S.,
99	relating to rulemaking power of the agency; conforming
100	provisions to changes made by the act; repealing s.
101	390.013, F.S., relating to effective date of rules
102	governing abortion clinics; amending s. 390.014, F.S.;
103	providing applicability of licensure requirements under
104	pt. II of ch. 408, F.S., to abortion clinics; increasing
105	fees for licensing of abortion clinics; repealing s.
106	390.015, F.S., relating to application for license to
107	operate an abortion clinic; repealing s. 390.016, F.S.,
108	relating to expiration and renewal of license; repealing
109	s. 390.017, F.S., relating to grounds for suspension or
110	revocation of license; amending s. 390.018, F.S.;
111	providing applicability of pt. II of ch. 408, F.S., to
112	administrative fines; repealing s. 390.019, F.S., relating
113	to inspections and investigations of abortion clinics;
114	repealing s. 390.021, F.S., relating to injunctive relief;
115	amending s. 393.501, F.S.; revising provisions relating to
116	rulemaking; amending s. 394.455, F.S.; revising a
117	definition; amending s. 394.4787, F.S.; conforming a cross
118	reference; amending s. 394.67, F.S.; deleting and revising
119	and providing definitions; conforming cross references;
120	amending ss. 394.74 and 394.82, F.S.; conforming cross
121	references; amending s. 394.875, F.S.; providing purpose
122	of short-term residential treatment facilities; providing
123	applicability of licensure requirements under pt. II of
124	ch. 408, F.S., to crisis stabilization units, short-term
125	residential treatment facilities, residential treatment
126	facilities, and residential treatment centers for children
127	and adolescents; providing an exemption from licensure
128	requirements for hospitals licensed under ch. 395, F.S.,
129	and certain programs operated therein; repealing s.
130	394.876, F.S., relating to license applications; amending
131	s. 394.877, F.S.; providing applicability of pt. II of ch.
132	408, F.S., to license fees; amending s. 394.878, F.S.,
133	relating to issuance and renewal of licenses; conforming
134	provisions to changes made by the act; amending s.
135	394.879, F.S.; providing for rulemaking authority;
136	conforming provisions to changes made by the act; amending
137	s. 394.90, F.S.; conforming provisions relating to
138	inspections of crisis stabilization units and residential
139	treatment facilities to changes made by the act; repealing
140	s. 394.902, F.S., relating to denial, suspension, and
141	revocation of licenses of certain mental health
142	facilities; amending s. 394.907, F.S., relating to access
143	to records of community mental health centers; providing
144	for the department to determine licensee compliance with
145	quality assurance programs; amending s. 395.002, F.S.;
146	deleting a definition; conforming cross references;
147	amending ss. 395.003, 395.004, and 395.0161, F.S.;
148	providing applicability of licensure requirements under
149	pt. II of ch. 408, F.S., to hospitals, ambulatory surgical
150	centers, and mobile surgical facilities; repealing s.
151	395.0055, F.S., relating to background screening;
152	repealing s. 395.0162, F.S., relating to inspection
153	reports; amending s. 395.0163, F.S.; revising provisions
154	relating to deposit of fees; conforming provisions to
155	changes made by the act; providing an exception to Florida
156	Building Code requirements for a licensed facility under
157	specified circumstances; amending s. 395.0191, F.S.;
158	requiring the presence of certain registered nurses in the
159	operating room of a facility licensed under ch. 395, F.S.,
160	during specified procedures; amending s. 395.0193, F.S.;
161	requiring that reports concerning disciplinary actions be
162	reported to the Department of Health and that final
163	disciplinary actions be reported to the Division of Health
164	Quality Assurance; conforming a cross reference; amending
165	s. 395.0197, F.S.; conforming a cross reference; amending
166	ss. 395.0199 and 395.1046, F.S.; providing applicability
167	of licensure requirements under pt. II of ch. 408, F.S.,
168	to health care utilization review and complaint
169	investigation procedures; amending s. 395.1055, F.S.;
170	providing applicability of licensure requirements under
171	pt. II of ch. 408, F.S., to adoption and enforcement of
172	rules; requiring the agency to enforce compliance with
173	provisions relating to specified immunizations; amending
174	ss. 395.1065, 395.10973, and 395.10974, F.S.; providing
175	applicability of licensure requirements under pt. II of
176	ch. 408, F.S., to administrative penalties and
177	injunctions, rulemaking, and health care risk managers;
178	amending ss. 395.602 and 395.701, F.S.; conforming cross
179	references; amending s. 400.021, F.S.; deleting
180	definitions; amending s. 400.022, F.S.; providing
181	applicability of licensure requirements under pt. II of
182	ch. 408, F.S., to grounds for action for a violation of
183	residents' rights; amending s. 400.051, F.S.; conforming a
184	cross reference; amending s. 400.062, F.S.; providing
185	applicability of licensure requirements under pt. II of
186	ch. 408, F.S., to nursing homes and related health care
187	facilities; revising provisions relating to license fees;
188	amending s. 400.063, F.S.; conforming a cross reference;
189	amending ss. 400.071 and 400.0712, F.S.; providing
190	applicability of licensure requirements under pt. II of
191	ch. 408, F.S., to license applications; amending s.
192	400.102, F.S.; providing applicability of licensure
193	requirements under pt. II of ch. 408, F.S., to grounds for
194	action by the agency against a licensee; amending s.
195	400.111, F.S.; providing applicability of licensure
196	requirements under pt. II of ch. 408, F.S.; requiring a
197	licensee to disclose certain holdings of a controlling
198	interest; amending s. 400.1183, F.S.; revising a provision
199	requiring facilities to report resident grievances to the
200	agency; amending s. 400.121, F.S., relating to denial,
201	suspension, and revocation of licenses and administrative
202	fines; conforming provisions to changes made by the act;
203	repealing s. 400.125, F.S., relating to injunction
204	proceedings; amending s. 400.141, F.S.; revising timeframe
205	for submission of information related to staffing
206	requirements and number of vacant beds in a facility;
207	conforming a cross reference; amending s. 400.162, F.S.;
208	providing for payment of a deceased resident's funeral
209	services under certain circumstances; amending s. 400.179,
210	F.S.; revising provisions relating to liability for
211	Medicaid underpayments and overpayments; conforming
212	provisions to changes made by the act; amending s. 400.18,
213	F.S.; revising provisions relating to the closing of a
214	nursing home facility; conforming provisions to changes
215	made by the act; amending s. 400.19, F.S.; providing
216	applicability of licensure requirements under pt. II of
217	ch. 408, F.S., to nursing home facility inspections;
218	revising a provision relating to a fine; amending s.
219	400.191, F.S.; authorizing the agency to provide
220	electronic access to inspection reports; requiring the
221	agency to publish the Nursing Home Guide in printed and
222	electronic formats and providing information to be
223	included therein; revising information to be included on
224	the agency Internet site; revising provisions relating to
225	availability of nursing home facility records; amending s.
226	400.20, F.S.; revising language relating to nursing home
227	administrators; amending s. 400.23, F.S.; providing
228	applicability of pt. II of ch. 408, F.S., to rulemaking
229	for nursing home facilities; providing an alternative to
230	nursing home room requirements under the Florida Building
231	Code, under certain circumstances; requiring nursing home
232	facilities to document rooms not in compliance with the
233	Florida Building Code and to notify the agency of the
234	practice; amending s. 400.241, F.S.; providing
235	applicability of licensure requirements under pt. II of
236	ch. 408, F.S., to prohibited acts relating to
237	establishment, operation, or advertisement of nursing home
238	facilities; amending s. 400.402, F.S.; revising and
239	deleting definitions; amending s. 400.407, F.S.; providing
240	applicability of licensure requirements under pt. II of
241	ch. 408, F.S., to assisted living facilities; conforming
242	provisions to changes made by the act; providing an
243	exemption; amending s. 400.4075, F.S.; providing
244	applicability of licensure requirements under pt. II of
245	ch. 408, F.S., to limited mental health licenses; amending
246	s. 400.408, F.S., relating to penalties imposed on
247	unlicensed assisted living facilities; conforming
248	provisions to changes made by the act; amending ss.
249	400.411, 400.412, 400.414, 400.417, and 400.4174, F.S.;
250	providing applicability of licensure requirements under
251	pt. II of ch. 408, F.S., to assisted living facilities;
252	conforming provisions to changes made by the act;
253	repealing s. 400.415, F.S., relating to a moratorium on
254	admissions and notice thereof; amending s. 400.4176, F.S.;
255	conforming provisions to changes made by the act; amending
256	s. 400.4178, F.S.; deleting provisions exempting specified
257	nursing home facilities from fees for training and
258	education programs relating to special care for persons
259	with Alzheimer's disease or other related disorders;
260	amending ss. 400.418 and 400.419, F.S.; providing
261	applicability of pt. II of ch. 408, F.S., to provisions
262	relating to disposition and imposition of fees and fines
263	collected under pt. III of ch. 400, F.S.; conforming
264	provisions to changes made by the act; repealing s.
265	400.421, F.S., relating to injunctive proceedings;
266	amending s. 400.422, F.S.; conforming a cross reference;
267	amending s. 400.423, F.S.; transferring rulemaking
268	authority from the Department of Elderly Affairs to the
269	agency; amending s. 400.424, F.S.; providing that fines on
270	assisted living facilities for failure to comply with
271	certain refund provisions are not subject to s.
272	400.419(3), F.S.; amending ss. 400.4255, 400.4256,
273	400.427, and 400.4275, F.S.; conforming provisions to
274	changes made by the act; amending s. 400.426, F.S.;
275	conforming a cross reference; amending ss. 400.431 and
276	400.434, F.S.; providing applicability of licensure
277	requirements under pt. II of ch. 408, F.S., to the closing
278	of and right of entry and inspection of assisted living
279	facilities; amending s. 400.435, F.S.; revising provisions
280	relating to maintenance of records of inspection reports
281	for a specified period of time; amending s. 400.441, F.S.;
282	transferring rulemaking authority from the Department of
283	Elderly Affairs to the agency; deleting provisions
284	requiring submission of proposed rules and a report to the
285	Legislature; deleting a fee for copies of rules and
286	standards; conforming provisions to changes made by the
287	act; amending ss. 400.442 and 400.444, F.S.; conforming
288	provisions to changes made by the act; amending s.
289	400.447, F.S.; providing applicability of licensure
290	requirements under pt. II of ch. 408, F.S., to prohibited
291	acts and penalties for violation of said requirements;
292	repealing s. 400.451, F.S., relating to compliance by
293	existing facilities with applicable rules and standards;
294	amending ss. 400.452 and 400.454, F.S.; conforming
295	provisions to changes made by the act; amending ss.
296	400.464, 400.471, 400.474, and 400.484, F.S.; providing
297	applicability of licensure requirements under pt. II of
298	ch. 408, F.S., to home health agencies; amending s.
299	400.487, F.S.; revising contents of home health service
300	agreements; authorizing physician assistants and advanced
301	registered nurse practitioners to establish treatment
302	orders; amending s. 400.494, F.S.; conforming provisions
303	to changes made by the act; amending ss. 400.495 and
304	400.497, F.S.; providing applicability of licensure
305	requirements under pt. II of ch. 408, F.S., to the toll-
306	free central abuse hotline and rules establishing minimum
307	standards for home health aides; amending s. 400.506,
308	F.S.; providing applicability of licensure requirements
309	under pt. II of ch. 408, F.S., to nurse registries;
310	requiring a nurse registry to notify patients or their
311	families of the availability and costs of visits by
312	registered nurses; permitting physician assistants and
313	advanced registered nurse practitioners to sign a plan of
314	treatment; revising provisions relating to assessment of
315	costs related to certain investigations; amending s.
316	400.509, F.S.; providing applicability of pt. II of ch.
317	408, F.S., to the registration of companion or homemaker
318	service providers exempt from licensure; providing a fee
319	for registration; conforming provisions to changes made by
320	the act; amending s. 400.512, F.S.; conforming provisions
321	relating to the screening of home health agency, nurse
322	registry, companion, and homemaker personnel to changes
323	made by the act; repealing s. 400.515, F.S., relating to
324	injunction proceedings; amending s. 400.551, F.S.;
325	revising definitions; amending ss. 400.554, 400.555,
326	400.5565, 400.557, and 400.5572, F.S.; providing
327	applicability of licensure requirements under pt. II of
328	ch. 408, F.S., to adult day care centers; amending s.
329	400.556, F.S.; authorizing the agency to impose an
330	emergency action against an owner, operator, or employee
331	of an adult day care facility; revising grounds for action
332	by the agency against an owner, operator, or employee of
333	an adult day care facility; providing applicability of
334	licensure requirements under pt. II of ch. 408, F.S.;
335	repealing s. 400.5575, F.S., relating to disposition of
336	fees and fines; repealing s. 400.558, F.S., relating to
337	injunctive relief; amending ss. 400.559 and 400.56, F.S.;
338	providing applicability of licensure requirements under
339	pt. II of ch. 408, F.S., to the closing of and right of
340	entry and inspection of adult day care centers; amending
341	s. 400.562, F.S.; transferring rulemaking authority from
342	the Department of Elderly Affairs to the agency; deleting
343	a fee for copies of rules and standards; conforming
344	provisions to changes made by the act; repealing s.
345	400.564, F.S., relating to prohibited acts and penalties
346	therefor; amending ss. 400.602, 400.605, 400.606,
347	400.6065, and 400.607, F.S.; providing applicability of
348	licensure requirements under pt. II of ch. 408, F.S., to
349	hospices; conforming provisions to changes made by the
350	act; amending s. 400.6095, F.S.; conforming provisions
351	relating to rulemaking to changes made by the act;
352	amending ss. 400.617, 400.6211, and 400.625, F.S.;
353	conforming provisions relating to legislative intent and
354	purpose, rulemaking, training and education programs, and
355	residency agreements for adult family-care homes to
356	changes made by the act; amending ss. 400.619, 400.6194,
357	400.6196, and 400.621, F.S.; providing applicability of
358	licensure requirements under pt. II of ch. 408, F.S., to
359	adult family-care homes; repealing s. 400.622, F.S.,
360	relating to injunctive proceedings; amending s. 400.801,
361	F.S.; conforming provisions relating to homes for special
362	services to changes made by the act; providing a fee;
363	amending s. 400.805, F.S.; providing applicability of
364	licensure requirements under pt. II of ch. 408, F.S., to
365	transitional living facilities; providing a fee; amending
366	s. 400.902, F.S.; revising a definition; amending ss.
367	400.903, 400.905, 400.907, and 400.908, F.S.; providing
368	applicability of licensure requirements under pt. II of
369	ch. 408, F.S., to prescribed pediatric extended care
370	centers; repealing s. 400.906, F.S., relating to initial
371	application for a license; repealing s. 400.910, F.S.,
372	relating to expiration or renewal of a license and
373	conditional licenses; repealing s. 400.911, F.S., relating
374	to injunction proceedings; amending s. 400.912, F.S.;
375	conforming provisions relating to the closing of a
376	prescribed pediatric extended care center to changes made
377	by the act; repealing s. 400.913, F.S., relating to right
378	of entry and inspection; amending ss. 400.914 and 400.915,
379	F.S.; providing applicability of licensure requirements
380	under pt. II of ch. 408, F.S., to rules establishing
381	standards for and requirements for construction and
382	renovation of prescribed pediatric extended care centers;
383	repealing s. 400.916, F.S., relating to penalties for
384	prohibited acts; repealing s. 400.917, F.S., relating to
385	disposition of moneys from fines and fees; amending s.
386	400.925, F.S.; deleting and revising definitions; amending
387	ss. 400.93, 400.931, 400.932, 400.933, and 400.935, F.S.;
388	providing applicability of licensure requirements under
389	pt. II of ch. 408, F.S., to home medical equipment
390	providers; repealing s. 400.95, F.S., relating to notice
391	of toll-free telephone number for the central abuse
392	hotline; amending ss. 400.953 and 400.955, F.S.; revising
393	provisions relating to background screening of home
394	medical equipment provider personnel; repealing s.
395	400.956, F.S., relating to injunction proceedings;
396	amending s. 400.960, F.S.; deleting and revising
397	definitions; amending s. 400.962, F.S.; providing
398	applicability of licensure requirements under pt. II of
399	ch. 408, F.S., to intermediate care facilities for persons
400	with developmental disabilities; providing a fee;
401	repealing s. 400.963, F.S., relating to injunctive
402	proceedings; repealing s. 400.965, F.S., relating to
403	grounds for actions by the agency against the licensee;
404	amending s. 400.967, F.S.; providing applicability of
405	licensure requirements under pt. II of ch. 408, F.S., to
406	intermediate care facilities for persons with
407	developmental disabilities; requiring facilities to adhere
408	to the Bill of Rights of Persons Who are Developmentally
409	Disabled; amending s. 400.968, F.S.; conforming provisions
410	relating to injunctive proceedings and a moratorium on
411	admissions to changes made by the act; amending s.
412	400.9685, F.S.; conforming language to changes made by the
413	act; amending s. 400.969, F.S.; providing applicability of
414	pt. II of ch. 408, F.S., to penalties relating to
415	intermediate care facilities for persons with
416	developmental disabilities; amending s. 400.980, F.S.;
417	providing applicability of licensure requirements under
418	pt. II of ch. 408, F.S., to health care services pools;
419	amending ss. 400.991, 400.9915, 400.9925, 400.993, and
420	400.9935, F.S.; providing applicability of licensure
421	requirements under pt. II of ch. 408, F.S., to health care
422	clinics; providing a fee; repealing s. 400.992, F.S.,
423	relating to license renewal, transfer of ownership, and
424	provisional licenses; repealing s. 400.994, F.S., relating
425	to injunctive proceedings; repealing s. 400.9945, F.S.,
426	relating to agency actions; amending s. 400.995, F.S.;
427	conforming provisions relating to agency administrative
428	penalties to changes made by the act; amending s. 401.265,
429	F.S.; requiring license requirements for emergency medical
430	technicians and paramedics; amending s. 408.831, F.S.;
431	revising provisions relating to agency action to deny,
432	suspend, or revoke a license or application; amending s.
433	440.102, F.S.; providing applicability of licensure
434	requirements under pt. II of ch. 408, F.S., to drug
435	testing standards for laboratories; amending s. 464.015,
436	F.S.; providing restrictions on the use of the title
437	"Certified Registered Nurse Anesthetist"; amending s.
438	464.016, F.S.; providing a penalty for misuse of the title
439	"Certified Registered Nurse Anesthetist"; amending ss.
440	483.035, 483.051, 483.061, 483.091, 483.101, 483.111,
441	483.172, 483.201, 483.221, and 483.23, F.S.; providing
442	applicability of licensure requirements under pt. II of
443	ch. 408, F.S., to clinical laboratories; repealing s.
444	483.131, F.S., relating to the display of a license;
445	repealing s. 483.25, F.S., relating to injunctive
446	proceedings; amending ss. 483.291, 483.294, 483.30,
447	483.302, 483.317, 483.32, and 483.322, F.S.; providing
448	applicability of licensure requirements under pt. II of
449	ch. 408, F.S., to multiphasic health testing centers;
450	repealing s. 483.311, F.S., relating to the display of a
451	license; repealing s. 483.328, F.S., relating to
452	injunctive relief; amending s. 765.541, F.S.; conforming
453	provisions relating to cadaveric organ and tissue
454	procurement to changes made by the act; amending s.
455	765.542, F.S.; providing applicability of licensure
456	requirements under pt. II of ch. 408, F.S., to organ
457	procurement organizations and tissue and eye banks;
458	amending s. 765.544, F.S.; conforming provisions relating
459	to application fees from organizations and tissue and eye
460	banks to changes made by the act; amending ss. 402.164,
461	409.815, 409.905, 409.907, 468.505, 483.106, 766.118,
462	766.316, and 812.014, F.S.; conforming cross references;
463	providing for priority of application in case of conflict;
464	transferring rules adopted by the Department of Elderly
465	Affairs under pts. III, V, VI, and VII of ch. 400, F.S.,
466	to the agency; authorizing the agency to issue licenses
467	for less than a specified time period and providing
468	conditions therefor; providing an effective date.
469
470	Be It Enacted by the Legislature of the State of Florida:
471
472	Section 1.  Part I of chapter 408, Florida Statutes,
473	consisting of sections 408.031, 408.032, 408.033, 408.034,
474	408.035, 408.036, 408.0361, 408.037, 408.038, 408.039, 408.040,
475	408.041, 408.042, 408.043, 408.044, 408.045, 408.0455, 408.05,
476	408.061, 408.062, 408.063, 408.07, 408.08, 408.09, 408.10,
477	408.15, 408.16, 408.18, 408.185, 408.20, 408.301, 408.302,
478	408.40, 408.50, 408.70, 408.7056, 408.7057, and 408.7071,
479	Florida Statutes, is created and entitled "Health Facility and
480	Services Planning."
481	Section 2.  Part II of chapter 408, Florida Statutes,
482	consisting of sections 408.801, 408.802, 408.803, 408.804,
483	408.805, 408.806, 408.807, 408.808, 408.809, 408.810, 408.811,
484	408.812, 408.813, 408.814, 408.815, 408.816, 408.817, 408.818,
485	408.819, and 408.831, Florida Statutes, is created and entitled
486	"Health Care Licensing: General Provisions."
487	Section 3.  Part III of chapter 408, Florida Statutes,
488	consisting of sections 408.90, 408.901, 408.902, 408.903,
489	408.904, 408.905, 408.906, 408.907, 408.908, and 408.909,
490	Florida Statutes, is created and entitled "Health Insurance
491	Access."
492	Section 4.  Part IV of chapter 408, Florida Statutes,
493	consisting of sections 408.911, 408.913, 408.914, 408.915,
494	408.916, 408.917, and 408.918, Florida Statutes, is created and
495	entitled "Health and Human Services Eligibility Access System."
496	Section 5.  Sections 408.801, 408.802, 408.803, 408.804,
497	408.805, 408.806, 408.807, 408.808, 408.809, 408.810, 408.811,
498	408.812, 408.813, 408.814, 408.815, 408.816, 408.817, 408.818,
499	and 408.819, Florida Statutes, are created to read:
500	408.801  Popular name; purpose.--
501	(1)  This part may be cited as the "Health Care Licensing
502	Procedures Act."
503	(2)  The Legislature finds that there is unnecessary
504	duplication and variation in the requirements for licensure by
505	the Agency for Health Care Administration brought about by the
506	historical pattern of legislative action focused exclusively on
507	a single type of regulated provider. It is the intent of the
508	Legislature to provide a streamlined and consistent set of basic
509	licensing requirements for all such providers in order to
510	minimize confusion, standardize terminology, and include issues
511	that are otherwise not adequately addressed in the Florida
512	Statutes pertaining to specific providers.
513	408.802  Applicability.--The provisions of this part apply
514	to the provision of services that require licensure as defined
515	in this part and to the following entities licensed, registered,
516	or certified by the Agency for Health Care Administration, as
517	described in chapters 112, 383, 390, 394, 395, 400, 440, 483,
518	and 765:
519	(1)  Laboratories authorized to perform testing under the
520	Drug-Free Workplace Act, as provided under ss. 112.0455 and
521	440.102.
522	(2)  Birth centers, as provided under chapter 383.
523	(3)  Abortion clinics, as provided under chapter 390.
524	(4)  Crisis stabilization units, as provided under parts I
525	and IV of chapter 394.
526	(5)  Short-term residential treatment facilities, as
527	provided under parts I and IV of chapter 394.
528	(6)  Residential treatment facilities, as provided under
529	part IV of chapter 394.
530	(7)  Residential treatment centers for children and
531	adolescents, as provided under part IV of chapter 394.
532	(8)  Hospitals, as provided under part I of chapter 395.
533	(9)  Ambulatory surgical centers, as provided under part I
534	of chapter 395.
535	(10)  Mobile surgical facilities, as provided under part I
536	of chapter 395.
537	(11)  Private review agents, as provided under part I of
538	chapter 395.
539	(12)  Health care risk managers, as provided under part I
540	of chapter 395.
541	(13)  Nursing homes, as provided under part II of chapter
542	400.
543	(14)  Assisted living facilities, as provided under part
544	III of chapter 400.
545	(15)  Home health agencies, as provided under part IV of
546	chapter 400.
547	(16)  Nurse registries, as provided under part IV of
548	chapter 400.
549	(17)  Companion services or homemaker services providers,
550	as provided under part IV of chapter 400.
551	(18)  Adult day care centers, as provided under part V of
552	chapter 400.
553	(19)  Hospices, as provided under part VI of chapter 400.
554	(20)  Adult family-care homes, as provided under part VII
555	of chapter 400.
556	(21)  Homes for special services, as provided under part
557	VIII of chapter 400.
558	(22)  Transitional living facilities, as provided under
559	part VIII of chapter 400.
560	(23)  Prescribed pediatric extended care centers, as
561	provided under part IX of chapter 400.
562	(24)  Home medical equipment providers, as provided under
563	part X of chapter 400.
564	(25)  Intermediate care facilities for persons with
565	developmental disabilities, as provided under part XI of chapter
566	400.
567	(26)  Health care services pools, as provided under part
568	XII of chapter 400.
569	(27)  Health care clinics, as provided under part XIII of
570	chapter 400.
571	(28)  Clinical laboratories, as provided under part I of
572	chapter 483.
573	(29)  Multiphasic health testing centers, as provided under
574	part II of chapter 483.
575	(30)  Organ and tissue procurement agencies, as provided
576	under chapter 765.
577	408.803  Definitions.--As used in this part, the term:
578	(1)  "Agency" means the Agency for Health Care
579	Administration, which is the licensing agency under this part.
580	(2)  "Applicant" means an individual, corporation,
581	partnership, firm, association, or governmental entity that
582	submits an application to the agency for a license.
583	(3)  "Authorizing statute" means the statute authorizing
584	the licensed operation of a provider listed in s. 408.802,
585	including chapters 112, 383, 390, 394, 395, 400, 440, 483, and
586	765.
587	(4)  "Certification" means certification as a Medicare or
588	Medicaid provider of the services that require licensure or
589	certification pursuant to the federal Clinical Laboratory
590	Improvement Amendment (CLIA).
591	(5)  "Change in ownership" means an event in which the
592	licensee changes to a different legal entity or in which 45
593	percent or more of the ownership, voting shares, or interest in
594	a corporation whose shares are not publicly traded on a
595	recognized stock exchange is transferred or assigned, including
596	the final transfer or assignment of multiple transfers or
597	assignments over a 2-year period that cumulatively total 45
598	percent or greater. However, a change solely in the management
599	company is not a change of ownership.
600	(6)  "Client" means any person receiving services from a
601	provider listed in s. 408.802.
602	(7)  "Controlling interest" means:
603	(a)  The applicant or licensee;
604	(b)  A person or entity that serves as an officer of, is on
605	the board of directors of, or has a 5 percent or greater
606	ownership interest in the applicant or licensee; or
607	(c)  A person or entity that serves as an officer of, is on
608	the board of directors of, or has a 5 percent or greater
609	ownership interest in the management company or other entity,
610	related or unrelated, with which the applicant or licensee
611	contracts to manage the provider.
612
613	The term does not include a voluntary board member.
614	(8)  "License" means any permit, registration, certificate,
615	or license issued by the agency.
616	(9)  "Licensee" means an individual, corporation,
617	partnership, firm, association, or governmental entity that is
618	issued a permit, registration, certificate, or license by the
619	agency. The licensee is legally responsible for all aspects of
620	the provider operation.
621	(10)  "Moratorium" means a prohibition on the acceptance of
622	new clients.
623	(11)  "Provider" means any activity, service, agency, or
624	facility regulated by the agency and listed in s. 408.802.
625	(12)  "Services that require licensure" means those
626	services, including residential services, that require a valid
627	license before those services may be provided in accordance with
628	authorizing statutes and agency rules.
629	(13)  "Voluntary board member" means a board member of a
630	not-for-profit corporation or organization who serves solely in
631	a voluntary capacity, does not receive any remuneration for his
632	or her services on the board of directors, and has no financial
633	interest in the corporation or organization. The agency shall
634	recognize a person as a voluntary board member following
635	submission of a statement to the agency by the board member and
636	the not-for-profit corporation or organization that affirms that
637	the board member conforms to this definition. The statement
638	affirming the status of the board member must be submitted to
639	the agency on a form provided by the agency.
640	408.804  License required; display.--
641	(1)  It is unlawful to provide services that require
642	licensure, or operate or maintain a provider that offers or
643	provides services that require licensure, without first
644	obtaining from the agency a license authorizing the provision of
645	such services or the operation or maintenance of such provider.
646	(2)  A license must be displayed in a conspicuous place
647	readily visible to clients who enter at the address that appears
648	on the license and is valid only in the hands of the licensee to
649	whom it is issued and may not be sold, assigned, or otherwise
650	transferred, voluntarily or involuntarily. The license is valid
651	only for the licensee, provider, and location for which the
652	license is issued.
653	408.805  Fees required; adjustments.--Unless otherwise
654	limited by authorizing statutes, license fees must be reasonably
655	calculated by the agency to cover its costs in carrying out its
656	responsibilities under this part, authorizing statutes, and
657	applicable rules, including the cost of licensure, inspection,
658	and regulation of providers.
659	(1)  Licensure fees shall be adjusted to provide for
660	biennial licensure in agency rules.
661	(2)  The agency shall annually adjust licensure fees,
662	including fees paid per bed, by not more than the change in the
663	Consumer Price Index based on the 12 months immediately
664	preceding the increase.
665	(3)  The agency may, by rule, adjust licensure fees to
666	cover the cost of administering this part, authorizing statutes,
667	and applicable rules.
668	(4)  An inspection fee must be paid as required in
669	authorizing statutes.
670	(5)  Fees are nonrefundable.
671	(6)  When a change is reported that requires issuance of a
672	license, a fee may be assessed. The fee must be based on the
673	actual cost of processing and issuing the license.
674	(7)  A fee may be charged to a licensee requesting a
675	duplicate license. The fee may not exceed the actual cost of
676	duplication and postage.
677	(8)  Total fees collected may not exceed the cost of
678	administering this part, authorizing statutes, and applicable
679	rules.
680	408.806  License application process.--
681	(1)  An application for licensure must be made to the
682	agency on forms furnished by the agency, submitted under oath,
683	and accompanied by the appropriate fee in order to be accepted
684	and considered timely. The application must contain information
685	required by authorizing statutes and applicable rules and must
686	include:
687	(a)  The name, address, and social security number of the
688	applicant and each controlling interest if the applicant or
689	controlling interest is an individual.
690	(b)  The name, address, and federal employer identification
691	number or taxpayer identification number of the applicant and
692	each controlling interest if the applicant or controlling
693	interest is not an individual.
694	(c)  The name by which the provider is to be known.
695	(d)  The total number of beds or capacity requested, as
696	applicable.
697	(e)  The following information regarding the location of
698	the provider for which the application is made:
699	1.  A report or letter from the zoning authority indicating
700	that the location is zoned appropriately for its use. If the
701	provider is a community residential home under chapter 419, the
702	zoning requirement must be satisfied by proof of compliance with
703	chapter 419. The zoning report or letter is not required for a
704	renewal application if the provider location did not change
705	since the date on which the most recent license was issued.
706	2.  A satisfactory fire safety report from the local
707	authority having jurisdiction or the state fire marshal.
708	(f)  The name of the person or persons under whose
709	management or supervision the provider will be operated and the
710	name of the administrator, if required.
711	(g)  If the applicant offers continuing care agreements as
712	defined in chapter 651, proof shall be furnished that the
713	applicant has obtained a certificate of authority as required
714	for operation under chapter 651.
715	(h)  Other information, including satisfactory inspection
716	results, that the agency finds necessary to determine the
717	ability of the applicant to carry out its responsibilities under
718	this part, authorizing statutes, and applicable rules.
719	(2)(a)  The applicant for a renewal license must submit an
720	application that must be received by the agency at least 60 days
721	prior to the expiration of the current license.
722	(b)  The applicant for initial licensure due to a change of
723	ownership must submit an application that must be received by
724	the agency at least 60 days prior to the date of change of
725	ownership.
726	(c)  For any other application or request, the applicant
727	must submit an application or request that must be received by
728	the agency at least 60 days prior to the requested effective
729	date, unless otherwise specified in authorizing statutes or
730	rules.
731	(d)  The agency shall notify the licensee by mail or
732	electronically at least 90 days prior to the expiration of a
733	license that a renewal license is necessary to continue
734	operation. The failure to timely file an application and submit
735	a license fee shall result in a late fee charged to the licensee
736	by the agency in an amount equal to 50 percent of the licensure
737	fee but in no event shall the aggregate amount of the fine
738	exceed $5,000. If an application is received after the required
739	filing date and exhibits a hand-canceled postmark obtained from
740	a United States Post Office dated on or before the required
741	filing date, no fine will be levied.
742	(3)(a)  Upon receipt of an application for a license, the
743	agency shall examine the application and, within 30 days after
744	receipt, notify the applicant in writing of any apparent errors
745	or omissions and request any additional information required.
746	(b)  Requested information omitted from an application for
747	licensure, license renewal, or change of ownership, other than
748	an inspection, must be filed with the agency within 21 days
749	after the agency's request for omitted information or the
750	application shall be deemed incomplete and shall be withdrawn
751	from further consideration and the fees shall be forfeited.
752	(c)  Within 60 days after the receipt of a complete
753	application, the agency shall approve or deny the application.
754	(4)(a)  Licensees subject to the provisions of this part
755	shall be issued biennial licenses unless conditions of the
756	license category specify a shorter license period.
757	(b)  Each license issued shall indicate the name of the
758	licensee, the type of provider or service that the licensee is
759	required or authorized to operate or offer, the date the license
760	is effective, the expiration date of the license, the maximum
761	capacity of the licensed premises, if applicable, and any other
762	information required or deemed necessary by the agency.
763	(5)  In accordance with authorizing statutes and applicable
764	rules, proof of compliance with s. 408.810 must be submitted
765	with an application for licensure.
766	(6)  The agency may not issue an initial license to a
767	health care provider subject to the certificate-of-need
768	provisions in part I of this chapter if the licensee has not
769	been issued a certificate of need or certificate-of-need
770	exemption, when applicable. Failure to apply for the renewal of
771	a license prior to the expiration date renders the license null
772	and void.
773	(7)(a)  An applicant must demonstrate compliance with the
774	requirements in this part, authorizing statutes, and applicable
775	rules during an inspection pursuant to s. 408.811, as required
776	by authorizing statutes.
777	(b)  An initial inspection is not required for companion
778	services or homemaker services providers, as provided under part
779	IV of chapter 400, or for health care services pools, as
780	provided under part XII of chapter 400.
781	(c)  If an inspection is required by the authorizing
782	statute for a license application other than an initial
783	application, the inspection must be unannounced. This paragraph
784	does not apply to inspections required pursuant to ss. 383.324,
785	395.0161(4), and 483.061(2).
786	(d)  If a provider is not available when an inspection is
787	attempted, the application shall be denied.
788	(8)  The agency may establish procedures for the electronic
789	submission of required information, including, but not limited
790	to:
791	(a)  Licensure applications.
792	(b)  Required signatures.
793	(c)  Payment of fees.
794	(d)  Notarization of applications.
795
796	Requirements for electronic submission of any documents required
797	by this part or authorizing statutes may be established by rule.
798	408.807  Change of ownership.--Whenever a change of
799	ownership occurs:
800	(1)  The transferor shall notify the agency in writing at
801	least 60 days before the anticipated date of the change of
802	ownership.
803	(2)  The transferee shall make application to the agency
804	for a license within the timeframes required in s. 408.806.
805	(3)  The transferor shall be responsible and liable for:
806	(a)  The lawful operation of the provider and the welfare
807	of the clients served until the date the transferee is licensed
808	by the agency.
809	(b)  Any and all penalties imposed against the transferor
810	for violations occurring before the date of change of ownership.
811	(4)  Any restriction on licensure, including a conditional
812	license existing at the time of a change of ownership, shall
813	remain in effect until removed by the agency.
814	(5)  The transferee shall maintain records of the
815	transferor as required in this part, authorizing statutes, and
816	applicable rules, including:
817	(a)  All client records.
818	(b)  Inspection reports.
819	(c)  All records required to be maintained pursuant to s.
820	409.913, if applicable.
821	408.808  License categories.--
822	(1)  STANDARD LICENSE.--A standard license may be issued to
823	an applicant at the time of initial licensure, license renewal,
824	or change of ownership. A standard license shall be issued when
825	the applicant is in compliance with all statutory requirements
826	and agency rules. Unless sooner revoked, a standard license
827	expires 2 years after the date of issue.
828	(2)  PROVISIONAL LICENSE.--A provisional license may be
829	issued to an applicant pursuant to s. 408.809(3). An applicant
830	against whom a proceeding denying or revoking a license is
831	pending at the time of license renewal may be issued a
832	provisional license effective until final agency action not
833	subject to further appeal.
834	(3)  INACTIVE LICENSE.--An inactive license may be issued
835	to a health care provider subject to the certificate-of-need
836	provisions in part I of this chapter when the provider is
837	currently licensed, does not have a provisional license, and
838	will be temporarily unable to provide services but is reasonably
839	expected to resume services within 12 months. Such designation
840	may be made for a period not to exceed 12 months but may be
841	renewed by the agency for up to 6 additional months upon
842	demonstration by the licensee of the provider's progress toward
843	reopening. A request by a licensee for an inactive license or to
844	extend the previously approved inactive period must be submitted
845	to the agency and include a written justification for the
846	inactive license with the beginning and ending dates of
847	inactivity specified, a plan for the transfer of any clients to
848	other providers, and the appropriate licensure fees. The agency
849	may not accept a request that is submitted after initiating
850	closure, after any suspension of service, or after notifying
851	clients of closure or suspension of service. Upon agency
852	approval, the provider shall notify clients of any necessary
853	discharge or transfer as required by authorizing statutes or
854	applicable rules. The beginning of the inactive license period
855	is the date the provider ceases operations. The end of the
856	inactive license period shall become the license expiration
857	date. All licensure fees must be current, must be paid in full,
858	and may be prorated. Reactivation of an inactive license
859	requires the approval of a renewal application, including
860	payment of licensure fees and agency inspections indicating
861	compliance with all requirements of this part, authorizing
862	statutes, and applicable rules.
863	(4)  OTHER LICENSES.--Other types of license categories may
864	be issued pursuant to authorizing statutes or applicable rules.
865	408.809  Background screening; prohibited offenses.--
866	(1)  Level 2 background screening pursuant to chapter 435
867	must be conducted through the agency on each of the following
868	persons, who shall be considered an employee for the purposes of
869	conducting screening under chapter 435:
870	(a)  The licensee, if an individual.
871	(b)  The administrator or a similarly titled person who is
872	responsible for the day-to-day operation of the provider.
873	(c)  The financial officer or similarly titled individual
874	who is responsible for the financial operation of the licensee
875	or provider.
876	(d)  Any person who is a controlling interest if the agency
877	has reason to believe that such person has been convicted of any
878	offense prohibited by s. 435.04. For each controlling interest
879	who has been convicted of any such offense, the licensee shall
880	submit to the agency a description and explanation of the
881	conviction at the time of license application.
882	(2)  Proof of compliance with level 2 screening standards
883	submitted within the previous 5 years to meet any provider or
884	professional licensure requirements of the agency, the
885	Department of Health, the Agency for Persons with Disabilities,
886	or the Department of Children and Family Services satisfies the
887	requirements of this section, provided that such proof is
888	accompanied, under penalty of perjury, by an affidavit of
889	compliance with the provisions of chapter 435 using forms
890	provided by the agency. Proof of compliance with the background
891	screening requirements of the Department of Financial Services
892	submitted within the previous 5 years for an applicant for a
893	certificate of authority to operate a continuing care retirement
894	community under chapter 651 satisfies the Department of Law
895	Enforcement and Federal Bureau of Investigation portions of a
896	level 2 background check.
897	(3)  A provisional license may be granted to an applicant
898	when each individual required by this section to undergo
899	background screening has met the standards for the Department of
900	Law Enforcement background check but the agency has not yet
901	received background screening results from the Federal Bureau of
902	Investigation. A standard license may be granted to the licensee
903	upon the agency's receipt of a report of the results of the
904	Federal Bureau of Investigation background screening for each
905	individual required by this section to undergo background
906	screening that confirms that all standards have been met or upon
907	the granting of an exemption from disqualification by the agency
908	as set forth in chapter 435.
909	(4)  When a change of any person required to be screened
910	under this section occurs, the licensee must notify the agency
911	of the change within the time period specified in the
912	authorizing statute or rules and must submit to the agency
913	information necessary to conduct level 2 screening or provide
914	evidence of compliance with background screening requirements of
915	this section. The person may serve in his or her capacity
916	pending the agency's receipt of the report from the Federal
917	Bureau of Investigation if he or she has met the standards for
918	the Department of Law Enforcement background check. However, the
919	person may not continue to serve if the report indicates any
920	violation of background screening standards unless an exemption
921	from disqualification has been granted by the agency as set
922	forth in chapter 435.
923	(5)  Background screening is not required to obtain a
924	certificate of exemption issued under s. 483.106.
925	408.810  Minimum licensure requirements.--In addition to
926	the licensure requirements specified in this part, authorizing
927	statutes, and applicable rules, each applicant and licensee must
928	comply with the requirements of this section in order to obtain
929	and maintain a license.
930	(1)  An applicant for licensure must comply with the
931	background screening requirements of s. 408.809.
932	(2)  An applicant for licensure must provide a description
933	and explanation of any exclusions, suspensions, or terminations
934	of the applicant from the Medicare, Medicaid, or federal
935	Clinical Laboratory Improvement Amendment (CLIA) programs.
936	(3)  Unless otherwise specified in this part, authorizing
937	statutes, or applicable rules, any information required to be
938	reported to the agency must be submitted within 21 calendar days
939	after the report period or effective date of the information.
940	(4)  Whenever a licensee discontinues operation of a
941	provider:
942	(a)  The licensee must inform the agency not less than 30
943	days prior to the discontinuance of operation and inform clients
944	of discharge as required by authorizing statutes. Immediately
945	upon discontinuance of operation of a provider, the licensee
946	shall surrender the license to the agency and the license shall
947	be canceled.
948	(b)  Upon closure of a provider, the licensee shall remain
949	responsible for retaining and appropriately distributing all
950	records within the timeframes prescribed in authorizing statutes
951	and applicable rules. In addition, the licensee or, in the event
952	of death or dissolution of a licensee, the estate or agent of
953	the licensee shall:
954	1.  Make arrangements to forward records for each client to
955	one of the following, based upon the client's choice: the client
956	or the client's legal representative, the client's attending
957	physician, or the health care provider where the client
958	currently receives services; or
959	2.  Cause a notice to be published in the newspaper of
960	greatest general circulation in the county where the provider
961	was located that advises clients of the discontinuance of the
962	provider operation. The notice must inform clients that they may
963	obtain copies of their records and specify the name, address,
964	and telephone number of the person from whom the copies of
965	records may be obtained. The notice must appear at least once a
966	week for 4 consecutive weeks. Failure to comply with this
967	paragraph is a misdemeanor of the second degree, punishable as
968	provided in s. 775.082 or s. 775.083.
969	(5)(a)  On or before the first day services are provided to
970	a client, a licensee must inform the client and his or her
971	immediate family or representative, if appropriate, of the right
972	to report:
973	1.  Complaints. The statewide toll-free telephone number
974	for reporting complaints to the agency must be provided to
975	clients in a manner that is clearly legible and must include the
976	words: "To report a complaint regarding the services you
977	receive, please call toll-free (phone number)."
978	2.  Abusive, neglectful, or exploitative practices. The
979	statewide toll-free telephone number for the central abuse
980	hotline must be provided to clients in a manner that is clearly
981	legible and must include the words: "To report abuse, neglect,
982	or exploitation, please call toll-free (phone number)." The
983	agency shall publish a minimum of a 90-day advance notice of a
984	change in the toll-free telephone numbers.
985	(b)  Each licensee shall establish appropriate policies and
986	procedures for providing such notice to clients.
987	(6)  An applicant must provide the agency with proof of the
988	applicant's legal right to occupy the property before a license
989	may be issued. Proof may include, but need not be limited to,
990	copies of warranty deeds, lease or rental agreements, contracts
991	for deeds, quitclaim deeds, or other such documentation.
992	(7)  If proof of insurance is required by the authorizing
993	statute, that insurance must be in compliance with chapter 624,
994	chapter 626, chapter 627, or chapter 628 and with agency rules.
995	(8)  Upon application for initial licensure or change-of-
996	ownership licensure, the applicant shall furnish satisfactory
997	proof of the applicant's financial ability to operate in
998	accordance with the requirements of this part, authorizing
999	statutes, and applicable rules. The agency shall establish
1000	standards for this purpose, including information concerning the
1001	applicant's controlling interests. The agency shall also
1002	establish documentation requirements, to be completed by each
1003	applicant, that show anticipated provider revenues and
1004	expenditures, the basis for financing the anticipated cash-flow
1005	requirements of the provider, and an applicant's access to
1006	contingency financing. A current certificate of authority,
1007	pursuant to chapter 651, may be provided as proof of financial
1008	ability to operate. The agency may require a licensee to provide
1009	proof of financial ability to operate at any time if there is
1010	evidence of financial instability, including, but not limited
1011	to, unpaid expenses necessary for the basic operations of the
1012	provider.
1013	(9)  A controlling interest may not withhold from the
1014	agency any evidence of financial instability of a licensed
1015	provider, including, but not limited to, checks returned due to
1016	insufficient funds, delinquent accounts, nonpayment of
1017	withholding taxes, unpaid utility expenses, nonpayment for
1018	essential services, or adverse court action concerning the
1019	financial viability of the provider or any other provider
1020	licensed under this part that is under the control of the
1021	controlling interest. Any person who violates this subsection
1022	commits a misdemeanor of the second degree, punishable as
1023	provided in s. 775.082 or s. 775.083. Each day of continuing
1024	violation is a separate offense.
1025	(10)  The agency may not issue a license to a health care
1026	provider subject to the certificate-of-need provisions in part I
1027	of this chapter if the health care provider has not been issued
1028	a certificate of need or an exemption. Upon initial licensure of
1029	any such provider, the authorization contained in the
1030	certificate of need shall be considered fully implemented and
1031	merged into the license and shall have no force and effect upon
1032	termination of the license for any reason.
1033	408.811  Right of inspection; copies; inspection reports.--
1034	(1)  An authorized officer or employee of the agency may
1035	make or cause to be made any inspection or investigation deemed
1036	necessary by the agency to determine the state of compliance
1037	with this part, authorizing statutes, and applicable rules. The
1038	right of inspection extends to any business that the agency has
1039	reason to believe is being operated as a provider without a
1040	license, but inspection of any business suspected of being
1041	operated without the appropriate license may not be made without
1042	the permission of the owner or person in charge unless a warrant
1043	is first obtained from a circuit court. Any application for a
1044	license issued under this part, authorizing statutes, or
1045	applicable rules constitutes permission for an appropriate
1046	inspection to verify the information submitted on or in
1047	connection with the application.
1048	(a)  All inspections shall be unannounced, except as
1049	specified in s. 408.806.
1050	(b)  Inspections for relicensure shall be conducted
1051	biennially unless otherwise specified by authorizing statutes or
1052	applicable rules.
1053	(2)  Inspections conducted in conjunction with
1054	certification may be accepted in lieu of a complete licensure
1055	inspection.  However, a licensure inspection may also be
1056	conducted to review any licensure requirements that are not also
1057	requirements for certification.
1058	(3)  The agency shall have access to and the licensee shall
1059	provide copies of all provider records required during an
1060	inspection at no cost to the agency.
1061	(4)(a)  Each licensee shall maintain as public information,
1062	available upon request, records of all inspection reports
1063	pertaining to that provider that have been filed by the agency
1064	unless those reports are exempt from or contain information that
1065	is exempt from s. 119.07(1) or is otherwise made confidential by
1066	law. Effective October 1, 2005, copies of such reports shall be
1067	retained in the records of the provider for at least 3 years
1068	following the date the reports are filed and issued, regardless
1069	of a change of ownership.
1070	(b)  A licensee shall, upon the request of any person who
1071	has completed a written application with intent to be admitted
1072	by such provider, any person who is a client of such provider,
1073	or any relative, spouse, or guardian of any such person, furnish
1074	to the requester a copy of the last inspection report pertaining
1075	to the licensed provider that was issued by the agency or by an
1076	accrediting organization if such report is used in lieu of a
1077	licensure inspection.
1078	408.812  Unlicensed activity.--
1079	(1)  A person or entity may not offer or advertise services
1080	that require licensure as defined by this part, authorizing
1081	statutes, or applicable rules to the public without obtaining a
1082	valid license from the agency. A licenseholder may not advertise
1083	or hold out to the public that he or she holds a license for
1084	other than that for which he or she actually holds the license.
1085	(2)  The operation or maintenance of an unlicensed provider
1086	or the performance of any services that require licensure
1087	without proper licensure is a violation of this part and
1088	authorizing statutes. Unlicensed activity constitutes harm that
1089	materially affects the health, safety, and welfare of clients.
1090	The agency or any state attorney may, in addition to other
1091	remedies provided in this part, bring an action for an
1092	injunction to restrain such violation or to enjoin the future
1093	operation or maintenance of any such provider or the provision
1094	of services that require licensure in violation of this part and
1095	authorizing statutes until compliance with this part,
1096	authorizing statutes, and agency rules has been demonstrated to
1097	the satisfaction of the agency.
1098	(3)  Any person or entity that owns, operates, or maintains
1099	an unlicensed provider and that, after receiving notification
1100	from the agency, fails to cease operation and apply for a
1101	license under this part and authorizing statutes commits a
1102	felony of the third degree, punishable as provided in s.
1103	775.082, s. 775.083, or s. 775.084. Each day of continued
1104	operation is a separate offense.
1105	(4)  Any person or entity found who violates subsection (3)
1106	a second or subsequent time commits a felony of the second
1107	degree, punishable as provided in s. 775.082, s. 775.083, or s.
1108	775.084. Each day of continued operation is a separate offense.
1109	(5)  Any person or entity that fails to cease operation
1110	after agency notification may be fined $1,000 for each day of
1111	noncompliance.
1112	(6)  When a controlling interest or licensee has an
1113	interest in more than one provider and fails to license a
1114	provider rendering services that require licensure, the agency
1115	may revoke all licenses, impose actions under s. 408.814, and
1116	impose a fine of $1,000 per day unless otherwise specified by
1117	authorizing statutes against each licensee until such time as
1118	the appropriate license is obtained for the unlicensed
1119	operation.
1120	(7)  In addition to granting injunctive relief pursuant to
1121	subsection (2), if the agency determines that a person or entity
1122	is operating or maintaining a provider without obtaining a
1123	license and determines that a condition exists that poses a
1124	threat to the health, safety, or welfare of a client of the
1125	provider, the person or entity is subject to the same actions
1126	and fines imposed against a licensee as specified in this part,
1127	authorizing statutes, and agency rules.
1128	(8)  Any person aware of the operation of an unlicensed
1129	provider must report that provider to the agency.
1130	408.813  Administrative fines.--As a penalty for any
1131	violation of this part, authorizing statutes, or applicable
1132	rules, the agency may impose an administrative fine. Unless the
1133	amount or aggregate limitation of the fine is prescribed by
1134	authorizing statutes or applicable rules, the agency may
1135	establish criteria by rule for the amount of administrative
1136	fines applicable to this part, authorizing statutes, and
1137	applicable rules. Each day of violation constitutes a separate
1138	violation and is subject to a separate fine. For fines imposed
1139	by final order of the agency and not subject to further appeal,
1140	the violator shall pay the fine plus interest at the rate
1141	specified in s. 55.03 for each day beyond the date set by the
1142	agency for payment of the fine.
1143	408.814  Moratoriums; emergency suspensions.--
1144	(1)  The agency may impose an immediate moratorium or
1145	emergency suspension as defined in s. 120.60 on any provider if
1146	the agency determines that any condition related to the provider
1147	or licensee presents a threat to the health, safety, or welfare
1148	of a client.
1149	(2)  A provider or licensee, the license of which is denied
1150	or revoked, may be subject to immediate imposition of a
1151	moratorium or emergency suspension to run concurrently with
1152	licensure denial, revocation, or injunction.
1153	(3)  A moratorium or emergency suspension remains in effect
1154	after a change of ownership, unless the agency has determined
1155	that the conditions that created the moratorium, emergency
1156	suspension, or denial of licensure have been corrected.
1157	(4)  When a moratorium or emergency suspension is placed on
1158	a provider or licensee, notice of the action shall be posted and
1159	visible to the public at the location of the provider until the
1160	action is lifted.
1161	408.815  License or application denial; revocation.--
1162	(1)  In addition to the grounds provided in authorizing
1163	statutes, grounds that may be used by the agency for denying and
1164	revoking a license or change-of-ownership application include
1165	any of the following actions by a controlling interest:
1166	(a)  False representation of a material fact in the license
1167	application or omission of any material fact from the
1168	application.
1169	(b)  An intentional or negligent act materially affecting
1170	the health or safety of a client of the provider.
1171	(c)  A violation of this part, authorizing statutes, or
1172	applicable rules.
1173	(d)  A demonstrated pattern of deficient performance.
1174	(e)  The applicant, licensee, or controlling interest has
1175	been or is currently excluded, suspended, terminated from
1176	participation in the state Medicaid program, the Medicaid
1177	program of any other state, or the Medicare program.
1178	(2)  If a licensee lawfully continues to operate while a
1179	denial or revocation is pending in litigation, the licensee must
1180	continue to meet all other requirements of this part,
1181	authorizing statutes, and applicable rules and must file
1182	subsequent renewal applications for licensure and pay all
1183	licensure fees. The provisions of ss. 120.60(1) and
1184	408.806(3)(c) shall not apply to renewal applications filed
1185	during the time period in which the litigation of the denial or
1186	revocation is pending until that litigation is final.
1187	(3)  An action under s. 408.814 or denial of the license of
1188	the transferor may be grounds for denial of a change-of-
1189	ownership application of the transferee.
1190	408.816  Injunctions.--
1191	(1)  In addition to the other powers provided by this part
1192	and authorizing statutes, the agency may institute injunction
1193	proceedings in a court of competent jurisdiction to:
1194	(a)  Restrain or prevent the establishment or operation of
1195	a provider that does not have a license or is in violation of
1196	any provision of this part, authorizing statutes, or applicable
1197	rules. The agency may also institute injunction proceedings in a
1198	court of competent jurisdiction when a violation of this part,
1199	authorizing statutes, or applicable rules constitutes an
1200	emergency affecting the immediate health and safety of a client.
1201	(b)  Enforce the provisions of this part, authorizing
1202	statutes, or any minimum standard, rule, or order issued or
1203	entered into pursuant thereto when the attempt by the agency to
1204	correct a violation through administrative sanctions has failed
1205	or when the violation materially affects the health, safety, or
1206	welfare of clients or involves any operation of an unlicensed
1207	provider.
1208	(c)  Terminate the operation of a provider when a violation
1209	of any provision of this part, authorizing statutes, or any
1210	standard or rule adopted pursuant thereto exists that materially
1211	affects the health, safety, or welfare of clients.
1212
1213	Such injunctive relief may be temporary or permanent.
1214	(2)  If action is necessary to protect clients of providers
1215	from immediate, life-threatening situations, the court may allow
1216	a temporary injunction without bond upon proper proof being
1217	made. If it appears by competent evidence or a sworn,
1218	substantiated affidavit that a temporary injunction should be
1219	issued, the court, pending the determination on final hearing,
1220	shall enjoin the operation of the provider.
1221	408.817  Administrative proceedings.--Administrative
1222	proceedings challenging agency licensure enforcement action
1223	shall be reviewed on the basis of the facts and conditions that
1224	resulted in the agency action.
1225	408.818  Health Care Trust Fund.--Unless otherwise
1226	prescribed by authorizing statutes, all fees and fines collected
1227	under this part, authorizing statutes, and applicable rules
1228	shall be deposited into the Health Care Trust Fund, created in
1229	s. 408.16, and used to pay the costs of the agency in
1230	administering the provider program paying the fees or fines.
1231	408.819  Rules.--The agency is authorized to adopt rules as
1232	necessary to administer this part. Any licensed provider that is
1233	in operation at the time of adoption of any applicable rule
1234	under this part or authorizing statutes shall be given a
1235	reasonable time under the particular circumstances, not to
1236	exceed 6 months after the date of such adoption, within which to
1237	comply with such rule, unless otherwise specified by rule.
1238	Section 6.  Subsections (12) and (17) and paragraph (a) of
1239	subsection (13) of section 112.0455, Florida Statutes, are
1240	amended to read:
1241	112.0455  Drug-Free Workplace Act.--
1242	(12)  DRUG-TESTING STANDARDS; LABORATORIES.--
1243	(a)  The requirements of part II of chapter 408 shall apply
1244	to the provision of services that require licensure pursuant to
1245	this section and part II of chapter 408 and to entities licensed
1246	by or applying for such licensure from the Agency for Health
1247	Care Administration pursuant to this section.
1248	(b)(a)  A laboratory may analyze initial or confirmation
1249	drug specimens only if:
1250	1.  The laboratory is licensed and approved by the Agency
1251	for Health Care Administration using criteria established by the
1252	United States Department of Health and Human Services as general
1253	guidelines for modeling the state drug testing program and in
1254	accordance with part II of chapter 408. Each applicant for
1255	licensure and licensee must comply with all requirements of part
1256	II of chapter 408 except s. 408.810(5)-(10). the following
1257	requirements:
1258	a.  Upon receipt of a completed, signed, and dated
1259	application, the agency shall require background screening, in
1260	accordance with the level 2 standards for screening set forth in
1261	chapter 435, of the managing employee, or other similarly titled
1262	individual responsible for the daily operation of the
1263	laboratory, and of the financial officer, or other similarly
1264	titled individual who is responsible for the financial operation
1265	of the laboratory, including billings for services. The
1266	applicant must comply with the procedures for level 2 background
1267	screening as set forth in chapter 435, as well as the
1268	requirements of s. 435.03(3).
1269	b.  The agency may require background screening of any
1270	other individual who is an applicant if the agency has probable
1271	cause to believe that he or she has been convicted of an offense
1272	prohibited under the level 2 standards for screening set forth
1273	in chapter 435.
1274	c.  Proof of compliance with the level 2 background
1275	screening requirements of chapter 435 which has been submitted
1276	within the previous 5 years in compliance with any other health
1277	care licensure requirements of this state is acceptable in
1278	fulfillment of screening requirements.
1279	d.  A provisional license may be granted to an applicant
1280	when each individual required by this section to undergo
1281	background screening has met the standards for the Department of
1282	Law Enforcement background check, but the agency has not yet
1283	received background screening results from the Federal Bureau of
1284	Investigation, or a request for a disqualification exemption has
1285	been submitted to the agency as set forth in chapter 435, but a
1286	response has not yet been issued. A license may be granted to
1287	the applicant upon the agency's receipt of a report of the
1288	results of the Federal Bureau of Investigation background
1289	screening for each individual required by this section to
1290	undergo background screening which confirms that all standards
1291	have been met, or upon the granting of a disqualification
1292	exemption by the agency as set forth in chapter 435. Any other
1293	person who is required to undergo level 2 background screening
1294	may serve in his or her capacity pending the agency's receipt of
1295	the report from the Federal Bureau of Investigation. However,
1296	the person may not continue to serve if the report indicates any
1297	violation of background screening standards and a
1298	disqualification exemption has not been requested of and granted
1299	by the agency as set forth in chapter 435.
1300	e.  Each applicant must submit to the agency, with its
1301	application, a description and explanation of any exclusions,
1302	permanent suspensions, or terminations of the applicant from the
1303	Medicare or Medicaid programs. Proof of compliance with the
1304	requirements for disclosure of ownership and control interests
1305	under the Medicaid or Medicare programs shall be accepted in
1306	lieu of this submission.
1307	f.  Each applicant must submit to the agency a description
1308	and explanation of any conviction of an offense prohibited under
1309	the level 2 standards of chapter 435 by a member of the board of
1310	directors of the applicant, its officers, or any individual
1311	owning 5 percent or more of the applicant. This requirement does
1312	not apply to a director of a not-for-profit corporation or
1313	organization if the director serves solely in a voluntary
1314	capacity for the corporation or organization, does not regularly
1315	take part in the day-to-day operational decisions of the
1316	corporation or organization, receives no remuneration for his or
1317	her services on the corporation or organization's board of
1318	directors, and has no financial interest and has no family
1319	members with a financial interest in the corporation or
1320	organization, provided that the director and the not-for-profit
1321	corporation or organization include in the application a
1322	statement affirming that the director's relationship to the
1323	corporation satisfies the requirements of this sub-subparagraph.
1324	g.  A license may not be granted to any applicant if the
1325	applicant or managing employee has been found guilty of,
1326	regardless of adjudication, or has entered a plea of nolo
1327	contendere or guilty to, any offense prohibited under the level
1328	2 standards for screening set forth in chapter 435, unless an
1329	exemption from disqualification has been granted by the agency
1330	as set forth in chapter 435.
1331	h.  The agency may deny or revoke licensure if the
1332	applicant:
1333	(I)  Has falsely represented a material fact in the
1334	application required by sub-subparagraph e. or sub-subparagraph
1335	f., or has omitted any material fact from the application
1336	required by sub-subparagraph e. or sub-subparagraph f.; or
1337	(II)  Has had prior action taken against the applicant
1338	under the Medicaid or Medicare program as set forth in sub-
1339	subparagraph e.
1340	i.  An application for license renewal must contain the
1341	information required under sub-subparagraphs e. and f.
1342	2.  The laboratory has written procedures to ensure chain
1343	of custody.
1344	3.  The laboratory follows proper quality control
1345	procedures, including, but not limited to:
1346	a.  The use of internal quality controls including the use
1347	of samples of known concentrations which are used to check the
1348	performance and calibration of testing equipment, and periodic
1349	use of blind samples for overall accuracy.
1350	b.  An internal review and certification process for drug
1351	test results, conducted by a person qualified to perform that
1352	function in the testing laboratory.
1353	c.  Security measures implemented by the testing laboratory
1354	to preclude adulteration of specimens and drug test results.
1355	d.  Other necessary and proper actions taken to ensure
1356	reliable and accurate drug test results.
1357	(c)(b)  A laboratory shall disclose to the employer a
1358	written test result report within 7 working days after receipt
1359	of the sample. All laboratory reports of a drug test result
1360	shall, at a minimum, state:
1361	1.  The name and address of the laboratory which performed
1362	the test and the positive identification of the person tested.
1363	2.  Positive results on confirmation tests only, or
1364	negative results, as applicable.
1365	3.  A list of the drugs for which the drug analyses were
1366	conducted.
1367	4.  The type of tests conducted for both initial and
1368	confirmation tests and the minimum cutoff levels of the tests.
1369	5.  Any correlation between medication reported by the
1370	employee or job applicant pursuant to subparagraph (8)(b)2. and
1371	a positive confirmed drug test result.
1372
1373	No report shall disclose the presence or absence of any drug
1374	other than a specific drug and its metabolites listed pursuant
1375	to this section.
1376	(d)(c)  The laboratory shall submit to the Agency for
1377	Health Care Administration a monthly report with statistical
1378	information regarding the testing of employees and job
1379	applicants. The reports shall include information on the methods
1380	of analyses conducted, the drugs tested for, the number of
1381	positive and negative results for both initial and confirmation
1382	tests, and any other information deemed appropriate by the
1383	Agency for Health Care Administration. No monthly report shall
1384	identify specific employees or job applicants.
1385	(e)(d)  Laboratories shall provide technical assistance to
1386	the employer, employee, or job applicant for the purpose of
1387	interpreting any positive confirmed test results which could
1388	have been caused by prescription or nonprescription medication
1389	taken by the employee or job applicant.
1390	(13)  RULES.--
1391	(a)  The Agency for Health Care Administration may adopt
1392	additional rules to support this law and part II of chapter 408,
1393	using criteria established by the United States Department of
1394	Health and Human Services as general guidelines for modeling
1395	drug-free workplace laboratories the state drug-testing program,
1396	concerning, but not limited to:
1397	1.  Standards for drug-testing laboratory licensing and
1398	denial, suspension, and revocation of a license.
1399	2.  Urine, hair, blood, and other body specimens and
1400	minimum specimen amounts which are appropriate for drug testing,
1401	not inconsistent with other provisions established by law.
1402	3.  Methods of analysis and procedures to ensure reliable
1403	drug-testing results, including standards for initial tests and
1404	confirmation tests, not inconsistent with other provisions
1405	established by law.
1406	4.  Minimum cutoff detection levels for drugs or their
1407	metabolites for the purposes of determining a positive test
1408	result, not inconsistent with other provisions established by
1409	law.
1410	5.  Chain-of-custody procedures to ensure proper
1411	identification, labeling, and handling of specimens being
1412	tested, not inconsistent with other provisions established by
1413	law.
1414	6.  Retention, storage, and transportation procedures to
1415	ensure reliable results on confirmation tests and retests.
1416	7.  A list of the most common medications by brand name or
1417	common name, as applicable, as well as by chemical name, which
1418	may alter or affect a drug test.
1419
1420	This section shall not be construed to eliminate the bargainable
1421	rights as provided in the collective bargaining process where
1422	applicable.
1423	(17)  LICENSE FEE.--Fees from licensure of drug-testing
1424	laboratories shall be sufficient to carry out the
1425	responsibilities of the Agency for Health Care Administration
1426	for the regulation of drug-testing laboratories. In accordance
1427	with s. 408.805, applicants and licensees shall pay a fee for
1428	each license application submitted under this part, part II of
1429	chapter 408, and applicable rules. The fee shall be not less
1430	than $16,000 or more than $20,000 per biennium and shall be
1431	established by rule. The Agency for Health Care Administration
1432	shall collect fees for all licenses issued under this part. Each
1433	nonrefundable fee shall be due at the time of application and
1434	shall be payable to the Agency for Health Care Administration to
1435	be deposited in a trust fund administered by the Agency for
1436	Health Care Administration and used only for the purposes of
1437	this section. The fee schedule is as follows: For licensure as a
1438	drug-testing laboratory, an annual fee of not less than $8,000
1439	or more than $10,000 per fiscal year; for late filing of an
1440	application for renewal, an additional fee of $500 per day shall
1441	be charged.
1442	Section 7.  Subsection (7) of section 381.0303, Florida
1443	Statutes, is amended to read:
1444	381.0303  Health practitioner recruitment for special needs
1445	shelters.--
1446	(7)  REVIEW OF EMERGENCY MANAGEMENT PLANS.--The submission
1447	of emergency management plans to county health departments by
1448	home health agencies pursuant to s. 400.497(8)(c) and (d) and by
1449	nurse registries pursuant to s. 400.506(11)(16)(e) and by
1450	hospice programs pursuant to s. 400.610(1)(b) is conditional
1451	upon the receipt of an appropriation by the department to
1452	establish medical services disaster coordinator positions in
1453	county health departments unless the secretary of the department
1454	and a local county commission jointly determine to require such
1455	plans to be submitted based on a determination that there is a
1456	special need to protect public health in the local area during
1457	an emergency.
1458	Section 8.  Paragraph (b) of subsection (4) of section
1459	381.78, Florida Statutes, is amended to read:
1460	381.78  Advisory council on brain and spinal cord
1461	injuries.--
1462	(4)  The council shall:
1463	(b)  Annually appoint a five-member committee composed of
1464	one individual who has a brain injury or has a family member
1465	with a brain injury, one individual who has a spinal cord injury
1466	or has a family member with a spinal cord injury, and three
1467	members who shall be chosen from among these representative
1468	groups: physicians, other allied health professionals,
1469	administrators of brain and spinal cord injury programs, and
1470	representatives from support groups with expertise in areas
1471	related to the rehabilitation of individuals who have brain or
1472	spinal cord injuries, except that one and only one member of the
1473	committee shall be an administrator of a transitional living
1474	facility. Membership on the council is not a prerequisite for
1475	membership on this committee.
1476	1.  The committee shall perform onsite visits to those
1477	transitional living facilities identified by the Agency for
1478	Health Care Administration as being in possible violation of the
1479	statutes and rules regulating such facilities. The committee
1480	members have the same rights of entry and inspection granted
1481	under s. 400.805(4)(8) to designated representatives of the
1482	agency.
1483	2.  Factual findings of the committee resulting from an
1484	onsite investigation of a facility pursuant to subparagraph 1.
1485	shall be adopted by the agency in developing its administrative
1486	response regarding enforcement of statutes and rules regulating
1487	the operation of the facility.
1488	3.  Onsite investigations by the committee shall be funded
1489	by the Health Care Trust Fund.
1490	4.  Travel expenses for committee members shall be
1491	reimbursed in accordance with s. 112.061.
1492	5.  Members of the committee shall recuse themselves from
1493	participating in any investigation that would create a conflict
1494	of interest under state law, and the council shall replace the
1495	member, either temporarily or permanently.
1496	Section 9.  Section 383.301, Florida Statutes, is amended
1497	to read:
1498	383.301  Licensure and regulation of birth centers;
1499	legislative intent.--It is the intent of the Legislature to
1500	provide for the protection of public health and safety in the
1501	establishment, maintenance, and operation of birth centers by
1502	providing for licensure of birth centers and for the
1503	development, establishment, and enforcement of minimum standards
1504	with respect to birth centers. The requirements of part II of
1505	chapter 408 shall apply to the provision of services that
1506	require licensure pursuant to ss. 383.30-383.335 and part II of
1507	chapter 408 and to entities licensed by or applying for such
1508	licensure from the Agency for Health Care Administration
1509	pursuant to ss. 383.30-383.335.
1510	Section 10.  Section 383.304, Florida Statutes, is
1511	repealed.
1512	Section 11.  Section 383.305, Florida Statutes, is amended
1513	to read:
1514	383.305  Licensure; issuance, renewal, denial, suspension,
1515	revocation; fees; background screening.--
1516	(1)(a)  In accordance with s. 408.805, an applicant or a
1517	licensee shall pay a fee for each license application submitted
1518	under ss. 383.30-383.335 and part II of chapter 408. The amount
1519	of the fee shall be established by rule. Upon receipt of an
1520	application for a license and the license fee, the agency shall
1521	issue a license if the applicant and facility have received all
1522	approvals required by law and meet the requirements established
1523	under ss. 383.30-383.335 and by rules promulgated hereunder.
1524	(b)  A provisional license may be issued to any birth
1525	center that is in substantial compliance with ss. 383.30-383.335
1526	and with the rules of the agency. A provisional license may be
1527	granted for a period of no more than 1 year from the effective
1528	date of rules adopted by the agency, shall expire automatically
1529	at the end of its term, and may not be renewed.
1530	(c)  A license, unless sooner suspended or revoked,
1531	automatically expires 1 year from its date of issuance and is
1532	renewable upon application for renewal and payment of the fee
1533	prescribed, provided the applicant and the birth center meet the
1534	requirements established under ss. 383.30-383.335 and by rules
1535	promulgated hereunder. A complete application for renewal of a
1536	license shall be made 90 days prior to expiration of the license
1537	on forms provided by the agency.
1538	(2)  An application for a license, or renewal thereof,
1539	shall be made to the agency upon forms provided by it and shall
1540	contain such information as the agency reasonably requires,
1541	which may include affirmative evidence of ability to comply with
1542	applicable laws and rules.
1543	(3)(a)  Each application for a birth center license, or
1544	renewal thereof, shall be accompanied by a license fee. Fees
1545	shall be established by rule of the agency. Such fees are
1546	payable to the agency and shall be deposited in a trust fund
1547	administered by the agency, to be used for the sole purpose of
1548	carrying out the provisions of ss. 383.30-383.335.
1549	(b)  The fees established pursuant to ss. 383.30-383.335
1550	shall be based on actual costs incurred by the agency in the
1551	administration of its duties under such sections.
1552	(4)  Each license is valid only for the person or
1553	governmental unit to whom or which it is issued; is not subject
1554	to sale, assignment, or other transfer, voluntary or
1555	involuntary; and is not valid for any premises other than those
1556	for which it was originally issued.
1557	(5)  Each license shall be posted in a conspicuous place on
1558	the licensed premises.
1559	(6)  Whenever the agency finds that there has been a
1560	substantial failure to comply with the requirements established
1561	under ss. 383.30-383.335 or in rules adopted under those
1562	sections, it is authorized to deny, suspend, or revoke a
1563	license.
1564	(2)(7)  Each applicant for licensure and each licensee must
1565	comply with the following requirements of part II of chapter 408
1566	except s. 408.810(7)-(10).:
1567	(a)  Upon receipt of a completed, signed, and dated
1568	application, the agency shall require background screening, in
1569	accordance with the level 2 standards for screening set forth in
1570	chapter 435, of the managing employee, or other similarly titled
1571	individual who is responsible for the daily operation of the
1572	center, and of the financial officer, or other similarly titled
1573	individual who is responsible for the financial operation of the
1574	center, including billings for patient care and services. The
1575	applicant must comply with the procedures for level 2 background
1576	screening as set forth in chapter 435 as well as the
1577	requirements of s. 435.03(3).
1578	(b)  The agency may require background screening of any
1579	other individual who is an applicant if the agency has probable
1580	cause to believe that he or she has been convicted of a crime or
1581	has committed any other offense prohibited under the level 2
1582	standards for screening set forth in chapter 435.
1583	(c)  Proof of compliance with the level 2 background
1584	screening requirements of chapter 435 which has been submitted
1585	within the previous 5 years in compliance with any other health
1586	care licensure requirements of this state is acceptable in
1587	fulfillment of the requirements of paragraph (a).
1588	(d)  A provisional license may be granted to an applicant
1589	when each individual required by this section to undergo
1590	background screening has met the standards for the Department of
1591	Law Enforcement background check, but the agency has not yet
1592	received background screening results from the Federal Bureau of
1593	Investigation, or a request for a disqualification exemption has
1594	been submitted to the agency as set forth in chapter 435 but a
1595	response has not yet been issued. A standard license may be
1596	granted to the applicant upon the agency's receipt of a report
1597	of the results of the Federal Bureau of Investigation background
1598	screening for each individual required by this section to
1599	undergo background screening which confirms that all standards
1600	have been met, or upon the granting of a disqualification
1601	exemption by the agency as set forth in chapter 435. Any other
1602	person who is required to undergo level 2 background screening
1603	may serve in his or her capacity pending the agency's receipt of
1604	the report from the Federal Bureau of Investigation. However,
1605	the person may not continue to serve if the report indicates any
1606	violation of background screening standards and a
1607	disqualification exemption has not been requested of and granted
1608	by the agency as set forth in chapter 435.
1609	(e)  Each applicant must submit to the agency, with its
1610	application, a description and explanation of any exclusions,
1611	permanent suspensions, or terminations of the applicant from the
1612	Medicare or Medicaid programs. Proof of compliance with the
1613	requirements for disclosure of ownership and control interests
1614	under the Medicaid or Medicare programs shall be accepted in
1615	lieu of this submission.
1616	(f)  Each applicant must submit to the agency a description
1617	and explanation of any conviction of an offense prohibited under
1618	the level 2 standards of chapter 435 by a member of the board of
1619	directors of the applicant, its officers, or any individual
1620	owning 5 percent or more of the applicant. This requirement does
1621	not apply to a director of a not-for-profit corporation or
1622	organization if the director serves solely in a voluntary
1623	capacity for the corporation or organization, does not regularly
1624	take part in the day-to-day operational decisions of the
1625	corporation or organization, receives no remuneration for his or
1626	her services on the corporation or organization's board of
1627	directors, and has no financial interest and has no family
1628	members with a financial interest in the corporation or
1629	organization, provided that the director and the not-for-profit
1630	corporation or organization include in the application a
1631	statement affirming that the director's relationship to the
1632	corporation satisfies the requirements of this paragraph.
1633	(g)  A license may not be granted to an applicant if the
1634	applicant or managing employee has been found guilty of,
1635	regardless of adjudication, or has entered a plea of nolo
1636	contendere or guilty to, any offense prohibited under the level
1637	2 standards for screening set forth in chapter 435, unless an
1638	exemption from disqualification has been granted by the agency
1639	as set forth in chapter 435.
1640	(h)  The agency may deny or revoke licensure if the
1641	applicant:
1642	1.  Has falsely represented a material fact in the
1643	application required by paragraph (e) or paragraph (f), or has
1644	omitted any material fact from the application required by
1645	paragraph (e) or paragraph (f); or
1646	2.  Has had prior action taken against the applicant under
1647	the Medicaid or Medicare program as set forth in paragraph (e).
1648	(i)  An application for license renewal must contain the
1649	information required under paragraphs (e) and (f).
1650	Section 12.  Section 383.309, Florida Statutes, is amended
1651	to read:
1652	383.309  Minimum standards for birth centers; rules and
1653	enforcement.--
1654	(1)  The agency shall adopt and enforce rules to administer
1655	ss. 383.30-383.335 and part II of chapter 408, which rules shall
1656	include, but are not limited to, reasonable and fair minimum
1657	standards for ensuring that:
1658	(a)  Sufficient numbers and qualified types of personnel
1659	and occupational disciplines are available at all times to
1660	provide necessary and adequate patient care and safety.
1661	(b)  Infection control, housekeeping, sanitary conditions,
1662	disaster plan, and medical record procedures that will
1663	adequately protect patient care and provide safety are
1664	established and implemented.
1665	(c)  Licensed facilities are established, organized, and
1666	operated consistent with established programmatic standards.
1667	(2)  Any licensed facility that is in operation at the time
1668	of adoption of any applicable rule under ss. 383.30-383.335
1669	shall be given a reasonable time under the particular
1670	circumstances, not to exceed 1 year after the date of such
1671	adoption, within which to comply with such rule.
1672	(2)(3)  The agency may not establish any rule governing the
1673	design, construction, erection, alteration, modification,
1674	repair, or demolition of birth centers. It is the intent of the
1675	Legislature to preempt that function to the Florida Building
1676	Commission and the State Fire Marshal through adoption and
1677	maintenance of the Florida Building Code and the Florida Fire
1678	Prevention Code. However, the agency shall provide technical
1679	assistance to the commission and the State Fire Marshal in
1680	updating the construction standards of the Florida Building Code
1681	and the Florida Fire Prevention Code which govern birth centers.
1682	In addition, the agency may enforce the special-occupancy
1683	provisions of the Florida Building Code and the Florida Fire
1684	Prevention Code which apply to birth centers in conducting any
1685	inspection authorized under this chapter.
1686	Section 13.  Subsection (1) of section 383.315, Florida
1687	Statutes, is amended to read:
1688	383.315  Agreements with consultants for advice or
1689	services; maintenance.--
1690	(1)  A birth center shall maintain in writing a
1691	consultation agreement, signed within the current license period
1692	year, with each consultant who has agreed to provide advice and
1693	services to the birth center as requested.
1694	Section 14.  Section 383.324, Florida Statutes, is amended
1695	to read:
1696	383.324  Inspections and investigations; Inspection fees.--
1697	(1)  The agency shall make or cause to be made such
1698	inspections and investigations as it deems necessary.
1699	(2)  Each facility licensed under s. 383.305 shall pay to
1700	the agency, at the time of inspection, an inspection fee
1701	established by rule of the agency.
1702	(3)  The agency shall coordinate all periodic inspections
1703	for licensure made by the agency to ensure that the cost to the
1704	facility of such inspections and the disruption of services by
1705	such inspections is minimized.
1706	Section 15.  Section 383.325, Florida Statutes, is
1707	repealed.
1708	Section 16.  Section 383.33, Florida Statutes, is amended
1709	to read:
1710	383.33  Administrative fines penalties; emergency orders;
1711	moratorium on admissions.--
1712	(1)(a)  In addition to the requirements of part II of
1713	chapter 408, the agency may deny, revoke, or suspend a license,
1714	or impose an administrative fine not to exceed $500 per
1715	violation per day, for the violation of any provision of ss.
1716	383.30-383.335, part II of chapter 408, or applicable rules or
1717	any rule adopted under ss. 383.30-383.335. Each day of violation
1718	constitutes a separate violation and is subject to a separate
1719	fine.
1720	(2)(b)  In determining the amount of the fine to be levied
1721	for a violation, as provided in subsection (1) paragraph (a),
1722	the following factors shall be considered:
1723	(a)1.  The severity of the violation, including the
1724	probability that death or serious harm to the health or safety
1725	of any person will result or has resulted; the severity of the
1726	actual or potential harm; and the extent to which the provisions
1727	of ss. 383.30-383.335, part II of chapter 408, or applicable
1728	rules were violated.
1729	(b)2.  Actions taken by the licensee to correct the
1730	violations or to remedy complaints.
1731	(c)3.  Any previous violations by the licensee.
1732	(c)  All amounts collected pursuant to this section shall
1733	be deposited into a trust fund administered by the agency to be
1734	used for the sole purpose of carrying out the provisions of ss.
1735	383.30-383.335.
1736	(2)  The agency may issue an emergency order immediately
1737	suspending or revoking a license when it determines that any
1738	condition in the licensed facility presents a clear and present
1739	danger to the public health and safety.
1740	(3)  The agency may impose an immediate moratorium on
1741	elective admissions to any licensed facility, building or
1742	portion thereof, or service when the agency determines that any
1743	condition in the facility presents a threat to the public health
1744	or safety.
1745	Section 17.  Section 383.331, Florida Statutes, is
1746	repealed.
1747	Section 18.  Section 383.332, Florida Statutes, is
1748	repealed.
1749	Section 19.  Subsection (1) of section 383.335, Florida
1750	Statutes, is amended to read:
1751	383.335  Partial exemptions.--
1752	(1)  Any facility that which was providing obstetrical and
1753	gynecological surgical services and was owned and operated by a
1754	board-certified obstetrician on June 15, 1984, and that which is
1755	otherwise subject to licensure under ss. 383.30-383.335 as a
1756	birth center, is exempt from the provisions of ss. 383.30-
1757	383.335 and part II of chapter 408 which restrict the provision
1758	of surgical services and outlet forceps delivery and the
1759	administration of anesthesia at birth centers. The agency shall
1760	adopt rules specifically related to the performance of such
1761	services and the administration of anesthesia at such
1762	facilities.
1763	Section 20.  Subsection (4) of section 383.50, Florida
1764	Statutes, is amended to read:
1765	383.50  Treatment of abandoned newborn infant.--
1766	(4)  Each hospital of this state subject to s. 395.1041
1767	shall, and any other hospital may, admit and provide all
1768	necessary emergency services and care, as defined in s.
1769	395.002(9)(10), to any newborn infant left with the hospital in
1770	accordance with this section. The hospital or any of its
1771	licensed health care professionals shall consider these actions
1772	as implied consent for treatment, and a hospital accepting
1773	physical custody of a newborn infant has implied consent to
1774	perform all necessary emergency services and care. The hospital
1775	or any of its licensed health care professionals is immune from
1776	criminal or civil liability for acting in good faith in
1777	accordance with this section. Nothing in this subsection limits
1778	liability for negligence.
1779	Section 21.  Subsection (5) of section 390.011, Florida
1780	Statutes, is amended to read:
1781	390.011  Definitions.--As used in this chapter, the term:
1782	(5)  "Hospital" means a facility as defined in s. 395.002
1783	and licensed under chapter 395.
1784	Section 22.  Subsection (1) of section 390.012, Florida
1785	Statutes, is amended to read:
1786	390.012  Powers of agency; rules; disposal of fetal
1787	remains.--
1788	(1)  The agency may shall have the authority to develop and
1789	enforce rules pursuant to ss. 390.001-390.018 and part II of
1790	chapter 408 for the health, care, and treatment of persons in
1791	abortion clinics and for the safe operation of such clinics.
1792	These rules shall be comparable to rules which apply to all
1793	surgical procedures requiring approximately the same degree of
1794	skill and care as the performance of first trimester abortions.
1795	The rules shall be reasonably related to the preservation of
1796	maternal health of the clients. The rules shall not impose a
1797	legally significant burden on a woman's freedom to decide
1798	whether to terminate her pregnancy. The rules shall provide for:
1799	(a)  The performance of pregnancy termination procedures
1800	only by a licensed physician.
1801	(b)  The making, protection, and preservation of patient
1802	records, which shall be treated as medical records under chapter
1803	458.
1804	Section 23.  Section 390.013, Florida Statutes, is
1805	repealed.
1806	Section 24.  Section 390.014, Florida Statutes, is amended
1807	to read:
1808	390.014  Licenses; fees, display, etc.--
1809	(1)  The requirements of part II of chapter 408 shall apply
1810	to the provision of services that require licensure pursuant to
1811	ss. 390.011-390.018 and part II of chapter 408 and to entities
1812	licensed by or applying for such licensure from the Agency for
1813	Health Care Administration pursuant to ss. 390.011-390.018.
1814	However, each applicant for licensure and each licensee is
1815	exempt from s. 408.810(7)-(10). No abortion clinic shall operate
1816	in this state without a currently effective license issued by
1817	the agency.
1818	(2)  A separate license shall be required for each clinic
1819	maintained on separate premises, even though it is operated by
1820	the same management as another clinic; but a separate license
1821	shall not be required for separate buildings on the same
1822	premises.
1823	(3)  In accordance with s. 408.805, an applicant or
1824	licensee shall pay a fee for each license application submitted
1825	under this part and part II of chapter 408. The amount of the
1826	fee shall be established by rule and The annual license fee
1827	required for a clinic shall be nonrefundable and shall be
1828	reasonably calculated to cover the cost of regulation under this
1829	chapter, but may not be less than $70 or $35 nor more than $500
1830	per biennium $250.
1831	(4)  Counties and municipalities applying for licenses
1832	under this act shall be exempt from the payment of the license
1833	fees.
1834	(5)  The license shall be displayed in a conspicuous place
1835	inside the clinic.
1836	(6)  A license shall be valid only for the clinic to which
1837	it is issued, and it shall not be subject to sale, assignment,
1838	or other transfer, voluntary or involuntary. No license shall be
1839	valid for any premises other than those for which it was
1840	originally issued.
1841	Section 25.  Section 390.015, Florida Statutes, is
1842	repealed.
1843	Section 26.  Section 390.016, Florida Statutes, is
1844	repealed.
1845	Section 27.  Section 390.017, Florida Statutes, is
1846	repealed.
1847	Section 28.  Section 390.018, Florida Statutes, is amended
1848	to read:
1849	390.018  Administrative fine penalty in lieu of revocation
1850	or suspension.--In addition to the requirements of part II of
1851	chapter 408 If the agency finds that one or more grounds exist
1852	for the revocation or suspension of a license issued to an
1853	abortion clinic, the agency may, in lieu of such suspension or
1854	revocation, impose a fine upon the clinic in an amount not to
1855	exceed $1,000 for each violation of any provision this part,
1856	part II of chapter 408, or applicable rules. The fine shall be
1857	paid to the agency within 60 days from the date of entry of the
1858	administrative order. If the licensee fails to pay the fine in
1859	its entirety to the agency within the period allowed, the
1860	license of the licensee shall stand suspended, revoked, or
1861	renewal or continuation may be refused, as the case may be, upon
1862	expiration of such period and without any further administrative
1863	or judicial proceedings.
1864	Section 29.  Section 390.019, Florida Statutes, is
1865	repealed.
1866	Section 30.  Section 390.021, Florida Statutes, is
1867	repealed.
1868	Section 31.  Subsection (13) of section 394.455, Florida
1869	Statutes, is amended to read:
1870	394.455  Definitions.--As used in this part, unless the
1871	context clearly requires otherwise, the term:
1872	(13)  "Hospital" means a facility as defined in s. 395.002
1873	and licensed under chapter 395.
1874	Section 32.  Subsection (7) of section 394.4787, Florida
1875	Statutes, is amended to read:
1876	394.4787  Definitions; ss. 394.4786, 394.4787, 394.4788,
1877	and 394.4789.--As used in this section and ss. 394.4786,
1878	394.4788, and 394.4789:
1879	(7)  "Specialty psychiatric hospital" means a hospital
1880	licensed by the agency pursuant to s. 395.002(28)(29) as a
1881	specialty psychiatric hospital.
1882	Section 33.  Subsections (3) through (23) of section
1883	394.67, Florida Statutes, are renumbered as subsections (2)
1884	through (22), respectively, present subsections (2) and (4) are
1885	amended, and a new subsection (23) is added to said section, to
1886	read:
1887	394.67  Definitions.--As used in this part, the term:
1888	(2)  "Applicant" means an individual applicant, or any
1889	officer, director, agent, managing employee, or affiliated
1890	person, or any partner or shareholder having an ownership
1891	interest equal to a 5-percent or greater interest in the
1892	corporation, partnership, or other business entity.
1893	(3)(4)  "Crisis services" means short-term evaluation,
1894	stabilization, and brief intervention services provided to a
1895	person who is experiencing an acute mental or emotional crisis,
1896	as defined in subsection (17) (18), or an acute substance abuse
1897	crisis, as defined in subsection (18) (19), to prevent further
1898	deterioration of the person's mental health. Crisis services are
1899	provided in settings such as a crisis stabilization unit, an
1900	inpatient unit, a short-term residential treatment program, a
1901	detoxification facility, or an addictions receiving facility; at
1902	the site of the crisis by a mobile crisis response team; or at a
1903	hospital on an outpatient basis.
1904	(23)  "Short-term residential treatment facility" means a
1905	facility that provides an alternative to inpatient
1906	hospitalization and that provides brief, intensive services 24
1907	hours a day, 7 days a week for mentally ill individuals who are
1908	temporarily in need of a 24-hour-a-day structured therapeutic
1909	setting as a less restrictive but longer-term alternative to
1910	hospitalization.
1911	Section 34.  Paragraph (a) of subsection (3) of section
1912	394.74, Florida Statutes, is amended to read:
1913	394.74  Contracts for provision of local substance abuse
1914	and mental health programs.--
1915	(3)  Contracts shall include, but are not limited to:
1916	(a)  A provision that, within the limits of available
1917	resources, substance abuse and mental health crisis services, as
1918	defined in s. 394.67(3)(4), shall be available to any individual
1919	residing or employed within the service area, regardless of
1920	ability to pay for such services, current or past health
1921	condition, or any other factor;
1922	Section 35.  Subsections (1) and (5) of section 394.82,
1923	Florida Statutes, are amended to read:
1924	394.82  Funding of expanded services.--
1925	(1)  Pursuant to the General Appropriations Acts for the
1926	2001-2002 and 2002-2003 fiscal years, funds appropriated to the
1927	Department of Children and Family Services for the purpose of
1928	expanding community mental health services must be used to
1929	implement programs that emphasize crisis services as defined in
1930	s. 394.67(3)(4) and treatment services, rehabilitative services,
1931	support services, and case management services, as defined in s.
1932	394.67(15)(16). Following the 2002-2003 fiscal year, the
1933	Department of Children and Family Services must continue to
1934	expand the provision of these community mental health services.
1935	(5)  By January 1, 2004, the crisis services defined in s.
1936	394.67(3)(4) shall be implemented, as appropriate, in the
1937	state's public community mental health system to serve children
1938	and adults who are experiencing an acute mental or emotional
1939	crisis, as defined in s. 394.67(17)(18). By January 1, 2006, the
1940	mental health services defined in s. 394.67(15)(16) shall be
1941	implemented, as appropriate, in the state's public community
1942	mental health system to serve adults and older adults who have a
1943	severe and persistent mental illness and to serve children who
1944	have a serious emotional disturbance or mental illness, as
1945	defined in s. 394.492(6).
1946	Section 36.  Section 394.875, Florida Statutes, is amended
1947	to read:
1948	394.875  Crisis stabilization units, short-term residential
1949	treatment facilities, residential treatment facilities, and
1950	residential treatment centers for children and adolescents;
1951	authorized services; license required; penalties.--
1952	(1)(a)  The purpose of a crisis stabilization unit is to
1953	stabilize and redirect a client to the most appropriate and
1954	least restrictive community setting available, consistent with
1955	the client's needs. Crisis stabilization units may screen,
1956	assess, and admit for stabilization persons who present
1957	themselves to the unit and persons who are brought to the unit
1958	under s. 394.463. Clients may be provided 24-hour observation,
1959	medication prescribed by a physician or psychiatrist, and other
1960	appropriate services. Crisis stabilization units shall provide
1961	services regardless of the client's ability to pay and shall be
1962	limited in size to a maximum of 30 beds.
1963	(b)  The purpose of a short-term residential treatment
1964	facility is to provide intensive services in a 24-hour-a-day
1965	structured therapeutic setting as a less restrictive but longer-
1966	term alternative to hospitalization.
1967	(c)(b)  The purpose of a residential treatment facility is
1968	to be a part of a comprehensive treatment program for mentally
1969	ill individuals in a community-based residential setting.
1970	(d)(c)  The purpose of a residential treatment center for
1971	children and adolescents is to provide mental health assessment
1972	and treatment services pursuant to ss. 394.491, 394.495, and
1973	394.496 to children and adolescents who meet the target
1974	population criteria specified in s. 394.493(1)(a), (b), or (c).
1975	(2)  The requirements of part II of chapter 408 shall apply
1976	to the provision of services that require licensure under ss.
1977	394.455-394.904 and part II of chapter 408 and to entities
1978	licensed by or applying for such licensure from the Agency for
1979	Health Care Administration pursuant to ss. 394.455-394.904.
1980	However, each applicant for licensure and each licensee is
1981	exempt from the provisions of s. 408.810(8)?(10). It is unlawful
1982	for any entity to hold itself out as a crisis stabilization
1983	unit, a residential treatment facility, or a residential
1984	treatment center for children and adolescents, or to act as a
1985	crisis stabilization unit, a residential treatment facility, or
1986	a residential treatment center for children and adolescents,
1987	unless it is licensed by the agency pursuant to this chapter.
1988	(3)  Any person who violates subsection (2) is guilty of a
1989	misdemeanor of the first degree, punishable as provided in s.
1990	775.082 or s. 775.083.
1991	(4)  The agency may maintain an action in circuit court to
1992	enjoin the unlawful operation of a crisis stabilization unit, a
1993	residential treatment facility, or a residential treatment
1994	center for children and adolescents if the agency first gives
1995	the violator 14 days' notice of its intention to maintain such
1996	action and if the violator fails to apply for licensure within
1997	such 14-day period.
1998	(3)(5)  The following are exempt from licensure as required
1999	in ss. 394.455-394.904 Subsection (2) does not apply to:
2000	(a)  Hospitals licensed pursuant to chapter 395 or programs
2001	operated within such hospitals. Homes for special services
2002	licensed under chapter 400; or
2003	(b)  Nursing homes licensed under chapter 400.
2004	(c)  Comprehensive transitional education programs licensed
2005	under s. 393.067.
2006	(4)(6)  The department, in consultation with the agency,
2007	may establish multiple license classifications for residential
2008	treatment facilities.
2009	(5)(7)  The agency may not issue a license to a crisis
2010	stabilization unit unless the unit receives state mental health
2011	funds and is affiliated with a designated public receiving
2012	facility.
2013	(6)(8)  The agency may issue a license for a crisis
2014	stabilization unit or short-term residential treatment facility,
2015	certifying the number of authorized beds for such facility as
2016	indicated by existing need and available appropriations. The
2017	agency may disapprove an application for such a license if it
2018	determines that a facility should not be licensed pursuant to
2019	the provisions of this chapter. Any facility operating beds in
2020	excess of those authorized by the agency shall, upon demand of
2021	the agency, reduce the number of beds to the authorized number,
2022	forfeit its license, or provide evidence of a license issued
2023	pursuant to chapter 395 for the excess beds.
2024	(7)(9)  A children's crisis stabilization unit which does
2025	not exceed 20 licensed beds and which provides separate
2026	facilities or a distinct part of a facility, separate staffing,
2027	and treatment exclusively for minors may be located on the same
2028	premises as a crisis stabilization unit serving adults. The
2029	department, in consultation with the agency, shall adopt rules
2030	governing facility construction, staffing and licensure
2031	requirements, and the operation of such units for minors.
2032	(8)(10)  The department, in consultation with the agency,
2033	must adopt rules governing a residential treatment center for
2034	children and adolescents which specify licensure standards for:
2035	admission; length of stay; program and staffing; discharge and
2036	discharge planning; treatment planning; seclusion, restraints,
2037	and time-out; rights of patients under s. 394.459; use of
2038	psychotropic medications; and standards for the operation of
2039	such centers.
2040	(9)(11)  Notwithstanding the provisions of subsection (8),
2041	crisis stabilization units may not exceed their licensed
2042	capacity by more than 10 percent, nor may they exceed their
2043	licensed capacity for more than 3 consecutive working days or
2044	for more than 7 days in 1 month.
2045	(10)(12)  Notwithstanding the other provisions of this
2046	section, any facility licensed under former chapter 396 and
2047	chapter 397 for detoxification, residential level I care, and
2048	outpatient treatment may elect to license concurrently all of
2049	the beds at such facility both for that purpose and as a long-
2050	term residential treatment facility pursuant to this section, if
2051	all of the following conditions are met:
2052	(a)  The licensure application is received by the
2053	department prior to January 1, 1993.
2054	(b)  On January 1, 1993, the facility was licensed under
2055	former chapter 396 and chapter 397 as a facility for
2056	detoxification, residential level I care, and outpatient
2057	treatment of substance abuse.
2058	(c)  The facility restricted its practice to the treatment
2059	of law enforcement personnel for a period of at least 12 months
2060	beginning after January 1, 1992.
2061	(d)  The number of beds to be licensed under this chapter
2062	is equal to or less than the number of beds licensed under
2063	former chapter 396 and chapter 397 as of January 1, 1993.
2064	(e)  The licensee agrees in writing to a condition placed
2065	upon the license that the facility will limit its treatment
2066	exclusively to law enforcement personnel and their immediate
2067	families who are seeking admission on a voluntary basis and who
2068	are exhibiting symptoms of posttraumatic stress disorder or
2069	other mental health problems, including drug or alcohol abuse,
2070	which are directly related to law enforcement work and which are
2071	amenable to verbal treatment therapies; the licensee agrees to
2072	coordinate the provision of appropriate postresidential care for
2073	discharged individuals; and the licensee further agrees in
2074	writing that a failure to meet any condition specified in this
2075	paragraph shall constitute grounds for a revocation of the
2076	facility's license as a residential treatment facility.
2077	(f)  The licensee agrees that the facility will meet all
2078	licensure requirements for a residential treatment facility,
2079	including minimum standards for compliance with lifesafety
2080	requirements, except those licensure requirements which are in
2081	express conflict with the conditions and other provisions
2082	specified in this subsection.
2083	(g)  The licensee agrees that the conditions stated in this
2084	subsection must be agreed to in writing by any person acquiring
2085	the facility by any means.
2086
2087	Any facility licensed under this subsection is not required to
2088	provide any services to any persons except those included in the
2089	specified conditions of licensure, and is exempt from any
2090	requirements related to the 60-day or greater average length of
2091	stay imposed on community-based residential treatment facilities
2092	otherwise licensed under this chapter.
2093	(13)  Each applicant for licensure must comply with the
2094	following requirements:
2095	(a)  Upon receipt of a completed, signed, and dated
2096	application, the agency shall require background screening, in
2097	accordance with the level 2 standards for screening set forth in
2098	chapter 435, of the managing employee and financial officer, or
2099	other similarly titled individual who is responsible for the
2100	financial operation of the facility, including billings for
2101	client care and services. The applicant must comply with the
2102	procedures for level 2 background screening as set forth in
2103	chapter 435, as well as the requirements of s. 435.03(3).
2104	(b)  The agency may require background screening of any
2105	other individual who is an applicant if the agency has probable
2106	cause to believe that he or she has been convicted of a crime or
2107	has committed any other offense prohibited under the level 2
2108	standards for screening set forth in chapter 435.
2109	(c)  Proof of compliance with the level 2 background
2110	screening requirements of chapter 435 which has been submitted
2111	within the previous 5 years in compliance with any other health
2112	care licensure requirements of this state is acceptable in
2113	fulfillment of the requirements of paragraph (a).
2114	(d)  A provisional license may be granted to an applicant
2115	when each individual required by this section to undergo
2116	background screening has met the standards for the Department of
2117	Law Enforcement background check, but the agency has not yet
2118	received background screening results from the Federal Bureau of
2119	Investigation, or a request for a disqualification exemption has
2120	been submitted to the agency as set forth in chapter 435, but a
2121	response has not yet been issued. A standard license may be
2122	granted to the applicant upon the agency's receipt of a report
2123	of the results of the Federal Bureau of Investigation background
2124	screening for each individual required by this section to
2125	undergo background screening which confirms that all standards
2126	have been met, or upon the granting of a disqualification
2127	exemption by the agency as set forth in chapter 435. Any other
2128	person who is required to undergo level 2 background screening
2129	may serve in his or her capacity pending the agency's receipt of
2130	the report from the Federal Bureau of Investigation. However,
2131	the person may not continue to serve if the report indicates any
2132	violation of background screening standards and a
2133	disqualification exemption has not been requested of and granted
2134	by the agency as set forth in chapter 435.
2135	(e)  Each applicant must submit to the agency, with its
2136	application, a description and explanation of any exclusions,
2137	permanent suspensions, or terminations of the applicant from the
2138	Medicare or Medicaid programs. Proof of compliance with the
2139	requirements for disclosure of ownership and control interests
2140	under the Medicaid or Medicare programs shall be accepted in
2141	lieu of this submission.
2142	(f)  Each applicant must submit to the agency a description
2143	and explanation of any conviction of an offense prohibited under
2144	the level 2 standards of chapter 435 by a member of the board of
2145	directors of the applicant, its officers, or any individual
2146	owning 5 percent or more of the applicant. This requirement does
2147	not apply to a director of a not-for-profit corporation or
2148	organization if the director serves solely in a voluntary
2149	capacity for the corporation or organization, does not regularly
2150	take part in the day-to-day operational decisions of the
2151	corporation or organization, receives no remuneration for his or
2152	her services on the corporation or organization's board of
2153	directors, and has no financial interest and has no family
2154	members with a financial interest in the corporation or
2155	organization, provided that the director and the not-for-profit
2156	corporation or organization include in the application a
2157	statement affirming that the director's relationship to the
2158	corporation satisfies the requirements of this paragraph.
2159	(g)  A license may not be granted to an applicant if the
2160	applicant or managing employee has been found guilty of,
2161	regardless of adjudication, or has entered a plea of nolo
2162	contendere or guilty to, any offense prohibited under the level
2163	2 standards for screening set forth in chapter 435, unless an
2164	exemption from disqualification has been granted by the agency
2165	as set forth in chapter 435.
2166	(h)  The agency may deny or revoke licensure if the
2167	applicant:
2168	1.  Has falsely represented a material fact in the
2169	application required by paragraph (e) or paragraph (f), or has
2170	omitted any material fact from the application required by
2171	paragraph (e) or paragraph (f); or
2172	2.  Has had prior action taken against the applicant under
2173	the Medicaid or Medicare program as set forth in paragraph (e).
2174	(i)  An application for license renewal must contain the
2175	information required under paragraphs (e) and (f).
2176	Section 37.  Section 394.876, Florida Statutes, is
2177	repealed.
2178	Section 38.  Section 394.877, Florida Statutes, is amended
2179	to read:
2180	394.877  Fees.--
2181	(1)  In accordance with s. 408.805, an applicant or
2182	licensee shall pay a fee for each license application submitted
2183	under this part, part II of chapter 408, and applicable rules.
2184	The amount of the fee shall be established by rule. Each
2185	application for licensure or renewal must be accompanied by a
2186	fee set by the department, in consultation with the agency, by
2187	rule. Such fees shall be reasonably calculated to cover only the
2188	cost of regulation under this chapter.
2189	(2)  All fees collected under this section shall be
2190	deposited in the Health Care Trust Fund.
2191	Section 39.  Section 394.878, Florida Statutes, is amended
2192	to read:
2193	394.878  Issuance and renewal of licenses.--
2194	(1)  Upon review of the application for licensure and
2195	receipt of appropriate fees, the agency shall issue an original
2196	or renewal license to any applicant that meets the requirements
2197	of this chapter.
2198	(2)  A license is valid for a period of 1 year. An
2199	applicant for renewal of a license shall apply to the agency no
2200	later than 90 days before expiration of the current license.
2201	(3)  A license may not be transferred from one entity to
2202	another and is valid only for the premises for which it was
2203	originally issued. For the purposes of this subsection,
2204	"transfer" includes, but is not limited to, transfer of a
2205	majority of the ownership interests in a licensee or transfer of
2206	responsibilities under the license to another entity by
2207	contractual arrangement.
2208	(4)  Each license shall state the services which the
2209	licensee is required or authorized to perform and the maximum
2210	residential capacity of the licensed premises.
2211	(1)(5)  The agency may issue a probationary license to an
2212	applicant that has completed the application requirements of
2213	this chapter but has not, at the time of the application,
2214	developed an operational crisis stabilization unit or
2215	residential treatment facility. The probationary license shall
2216	expire 90 days after issuance and may once be renewed for an
2217	additional 90-day period. The agency may cancel a probationary
2218	license at any time.
2219	(2)(6)  The agency may issue an interim license to an
2220	applicant that has substantially completed all application
2221	requirements and has initiated action to fully meet such
2222	requirements. The interim license shall expire 90 days after
2223	issuance and, in cases of extreme hardship, may once be renewed
2224	for an additional 90-day period.
2225	(7)  Any applicant which fails to file an application for
2226	license renewal during the 90-day relicensure period shall be
2227	considered unlicensed and subject to penalties pursuant to s.
2228	394.875.
2229	Section 40.  Subsections (1), (3), and (4) of section
2230	394.879, Florida Statutes, are amended to read:
2231	394.879  Rules; enforcement.--
2232	(1)  The agency, in consultation with the department, may
2233	adopt rules to implement the requirements of part II of chapter
2234	408. The department, in consultation with the agency, shall
2235	adopt rules pursuant to ss. 120.536(1) and 120.54 to implement
2236	the provisions of this chapter, including, at a minimum, rules
2237	providing standards to ensure that:
2238	(a)  Sufficient numbers and types of qualified personnel
2239	are on duty and available at all times to provide necessary and
2240	adequate client safety and care.
2241	(b)  Adequate space is provided each client of a licensed
2242	facility.
2243	(c)  Licensed facilities are limited to an appropriate
2244	number of beds.
2245	(d)  Each licensee establishes and implements adequate
2246	infection control, housekeeping, sanitation, disaster planning,
2247	and medical recordkeeping.
2248	(e)  Licensed facilities are established, organized, and
2249	operated in accordance with programmatic standards of the
2250	department.
2251	(f)  The operation and purposes of these facilities assure
2252	individuals' health, safety, and welfare.
2253	(3)  The department, in consultation with the agency, shall
2254	allow any licensed facility in operation at the time of adoption
2255	of any rule a reasonable period, not to exceed 1 year, to bring
2256	itself into compliance with department rules such rule.
2257	(4)  In accordance with part II of chapter 408, the agency
2258	may impose an administrative penalty of no more than $500 per
2259	day against any licensee that violates any rule adopted pursuant
2260	to this section and may suspend and or revoke the license and or
2261	deny the renewal application of such licensee. In imposing such
2262	penalty, the agency shall consider the severity of the
2263	violation, actions taken by the licensee to correct the
2264	violation, and previous violations by the licensee. Fines
2265	collected under this subsection shall be deposited in the Mental
2266	Health Facility Licensing Trust Fund.
2267	Section 41.  Paragraph (a) of subsection (1) of section
2268	394.90, Florida Statutes, is amended to read:
2269	394.90  Inspection; right of entry; records.--
2270	(1)(a)  The department and the agency, in accordance with
2271	s. 408.811, may enter and inspect at any time a licensed
2272	facility to determine whether the facility is in compliance with
2273	this chapter and the applicable rules of the department.
2274	Section 42.  Section 394.902, Florida Statutes, is
2275	repealed.
2276	Section 43.  Subsection (7) of section 394.907, Florida
2277	Statutes, is amended to read:
2278	394.907  Community mental health centers; quality assurance
2279	programs.--
2280	(7)  The department shall have access to all records
2281	necessary to determine licensee agency compliance with the
2282	provisions of this section. The records of quality assurance
2283	programs which relate solely to actions taken in carrying out
2284	the provisions of this section, and records obtained by the
2285	department to determine licensee agency compliance with this
2286	section, are confidential and exempt from s. 119.07(1). Such
2287	records are not admissible in any civil or administrative
2288	action, except in disciplinary proceedings by the Department of
2289	Business and Professional Regulation and the appropriate
2290	regulatory board, nor shall such records be available to the
2291	public as part of the record of investigation for, and
2292	prosecution in disciplinary proceedings made available to the
2293	public by the Department of Business and Professional Regulation
2294	or the appropriate regulatory board. Meetings or portions of
2295	meetings of quality assurance program committees that relate
2296	solely to actions taken pursuant to this section are exempt from
2297	s. 286.011.
2298	Section 44.  Subsections (5) through (33) of section
2299	395.002, Florida Statutes, are renumbered as subsections (4)
2300	through (32), respectively, and present subsections (4), (11),
2301	and (29) of said section are amended to read:
2302	395.002  Definitions.--As used in this chapter:
2303	(4)  "Applicant" means an individual applicant, or any
2304	officer, director, or agent, or any partner or shareholder
2305	having an ownership interest equal to a 5-percent or greater
2306	interest in the corporation, partnership, or other business
2307	entity.
2308	(10)(11)  "General hospital" means any facility which meets
2309	the provisions of subsection (12) (13) and which regularly makes
2310	its facilities and services available to the general population.
2311	(28)(29)  "Specialty hospital" means any facility which
2312	meets the provisions of subsection (12) (13), and which
2313	regularly makes available either:
2314	(a)  The range of medical services offered by general
2315	hospitals, but restricted to a defined age or gender group of
2316	the population;
2317	(b)  A restricted range of services appropriate to the
2318	diagnosis, care, and treatment of patients with specific
2319	categories of medical or psychiatric illnesses or disorders; or
2320	(c)  Intensive residential treatment programs for children
2321	and adolescents as defined in subsection (15) (16).
2322	Section 45.  Section 395.003, Florida Statutes, is amended
2323	to read:
2324	395.003  Licensure; issuance, renewal, denial,
2325	modification, suspension, and revocation.--
2326	(1)(a)  The requirements of part II of chapter 408 shall
2327	apply to the provision of services that require licensure
2328	pursuant to ss. 395.001-395.1065 and part II of chapter 408 and
2329	to entities licensed by or applying for such licensure from the
2330	Agency for Health Care Administration pursuant to ss. 395.001-
2331	395.1065. However, each applicant for licensure and each
2332	licensee is exempt from s. 408.810(7)-(9). Ambulatory surgical
2333	center and mobile surgical facility licensees and applicants for
2334	such licensure are also exempt from s. 408.810(10). A person may
2335	not establish, conduct, or maintain a hospital, ambulatory
2336	surgical center, or mobile surgical facility in this state
2337	without first obtaining a license under this part.
2338	(b)1.  It is unlawful for a person to use or advertise to
2339	the public, in any way or by any medium whatsoever, any facility
2340	as a "hospital," "ambulatory surgical center," or "mobile
2341	surgical facility" unless such facility has first secured a
2342	license under the provisions of this part.
2343	2.  This part does not apply to veterinary hospitals or to
2344	commercial business establishments using the word "hospital,"
2345	"ambulatory surgical center," or "mobile surgical facility" as a
2346	part of a trade name if no treatment of human beings is
2347	performed on the premises of such establishments.
2348	(c)3.  By December 31, 2004, the agency shall submit a
2349	report to the President of the Senate and the Speaker of the
2350	House of Representatives recommending whether it is in the
2351	public interest to allow a hospital to license or operate an
2352	emergency department located off the premises of the hospital.
2353	If the agency finds it to be in the public interest, the report
2354	shall also recommend licensure criteria for such medical
2355	facilities, including criteria related to quality of care and,
2356	if deemed necessary, the elimination of the possibility of
2357	confusion related to the service capabilities of such facility
2358	in comparison to the service capabilities of an emergency
2359	department located on the premises of the hospital. Until July
2360	1, 2005, additional emergency departments located off the
2361	premises of licensed hospitals may not be authorized by the
2362	agency.
2363	(2)(a)  Upon the receipt of an application for a license
2364	and the license fee, the agency shall issue a license if the
2365	applicant and facility have received all approvals required by
2366	law and meet the requirements established under this part and in
2367	rules. Such license shall include all beds and services located
2368	on the premises of the facility.
2369	(b)  A provisional license may be issued to a new facility
2370	or a facility that is in substantial compliance with this part
2371	and with the rules of the agency. A provisional license shall be
2372	granted for a period of no more than 1 year and shall expire
2373	automatically at the end of its term. A provisional license may
2374	not be renewed.
2375	(c)  A license, unless sooner suspended or revoked, shall
2376	automatically expire 2 years from the date of issuance and shall
2377	be renewable biennially upon application for renewal and payment
2378	of the fee prescribed by s. 395.004(2), provided the applicant
2379	and licensed facility meet the requirements established under
2380	this part and in rules. An application for renewal of a license
2381	shall be made 90 days prior to expiration of the license, on
2382	forms provided by the agency.
2383	(a)(d)  The agency shall, at the request of a licensee,
2384	issue a single license to a licensee for facilities located on
2385	separate premises. Such a license shall specifically state the
2386	location of the facilities, the services, and the licensed beds
2387	available on each separate premises. If a licensee requests a
2388	single license, the licensee shall designate which facility or
2389	office is responsible for receipt of information, payment of
2390	fees, service of process, and all other activities necessary for
2391	the agency to carry out the provisions of this part.
2392	(b)(e)  The agency shall, at the request of a licensee that
2393	is a teaching hospital as defined in s. 408.07(44), issue a
2394	single license to a licensee for facilities that have been
2395	previously licensed as separate premises, provided such
2396	separately licensed facilities, taken together, constitute the
2397	same premises as defined in s. 395.002(23)(24). Such license for
2398	the single premises shall include all of the beds, services, and
2399	programs that were previously included on the licenses for the
2400	separate premises. The granting of a single license under this
2401	paragraph shall not in any manner reduce the number of beds,
2402	services, or programs operated by the licensee.
2403	(c)(f)  Intensive residential treatment programs for
2404	children and adolescents which have received accreditation from
2405	the Joint Commission on Accreditation of Healthcare
2406	Organizations and which meet the minimum standards developed by
2407	rule of the agency for such programs shall be licensed by the
2408	agency under this part.
2409	(3)(a)  Each license shall be valid only for the person to
2410	whom it is issued and shall not be sold, assigned, or otherwise
2411	transferred, voluntarily or involuntarily. A license is only
2412	valid for the premises for which it was originally issued.
2413	(b)1.  An application for a new license is required if
2414	ownership, a majority of the ownership, or controlling interest
2415	of a licensed facility is transferred or assigned and when a
2416	lessee agrees to undertake or provide services to the extent
2417	that legal liability for operation of the facility rests with
2418	the lessee. The application for a new license showing such
2419	change shall be made at least 60 days prior to the date of the
2420	sale, transfer, assignment, or lease.
2421	(3)2.  After a change of ownership has occurred, the
2422	transferee shall be liable for any liability to the state,
2423	regardless of when identified, resulting from changes to
2424	allowable costs affecting provider reimbursement for Medicaid
2425	participation or Public Medical Assistance Trust Fund
2426	Assessments, and related administrative fines. The transferee,
2427	simultaneously with the transfer of ownership, shall pay or make
2428	arrangements to pay to the agency or the department any amount
2429	owed to the agency or the department; payment assurances may be
2430	in the form of an irrevocable credit instrument or payment bond
2431	acceptable to the agency or the department provided by or on
2432	behalf of the transferor. The issuance of a license to the
2433	transferee shall be delayed pending payment or until arrangement
2434	for payment acceptable to the agency or the department is made.
2435	(4)  The agency shall issue a license which specifies the
2436	service categories and the number of hospital beds in each bed
2437	category for which a license is received. Such information shall
2438	be listed on the face of the license. All beds which are not
2439	covered by any specialty-bed-need methodology shall be specified
2440	as general beds. A licensed facility shall not operate a number
2441	of hospital beds greater than the number indicated by the agency
2442	on the face of the license without approval from the agency
2443	under conditions established by rule.
2444	(5)(a)  Adherence to patient rights, standards of care, and
2445	examination and placement procedures provided under part I of
2446	chapter 394 shall be a condition of licensure for hospitals
2447	providing voluntary or involuntary medical or psychiatric
2448	observation, evaluation, diagnosis, or treatment.
2449	(b)  Any hospital that provides psychiatric treatment to
2450	persons under 18 years of age who have emotional disturbances
2451	shall comply with the procedures pertaining to the rights of
2452	patients prescribed in part I of chapter 394.
2453	(6)  No specialty hospital shall provide any service or
2454	regularly serve any population group beyond those services or
2455	groups specified in its license.
2456	(7)  Licenses shall be posted in a conspicuous place on
2457	each of the licensed premises.
2458	(7)(8)  In addition to the requirements of part II of
2459	chapter 408, whenever the agency finds that there has been a
2460	substantial failure to comply with the requirements established
2461	under this part or in rules, the agency is authorized to deny,
2462	modify, suspend, and or revoke:
2463	(a)  A license;
2464	(b)  That part of a license which is limited to a separate
2465	premises, as designated on the license; or
2466	(c)  Licensure approval limited to a facility, building, or
2467	portion thereof, or a service, within a given premises.
2468	(8)(9)  A hospital may not be licensed or relicensed if:
2469	(a)  The diagnosis-related groups for 65 percent or more of
2470	the discharges from the hospital, in the most recent year for
2471	which data is available to the Agency for Health Care
2472	Administration pursuant to s. 408.061, are for diagnosis, care,
2473	and treatment of patients who have:
2474	1.  Cardiac-related diseases and disorders classified as
2475	diagnosis-related groups 103-145, 478-479, 514-518, or 525-527;
2476	2.  Orthopedic-related diseases and disorders classified as
2477	diagnosis-related groups 209-256, 471, 491, 496-503, or 519-520;
2478	3.  Cancer-related diseases and disorders classified as
2479	diagnosis-related groups 64, 82, 172, 173, 199, 200, 203, 257-
2480	260, 274, 275, 303, 306, 307, 318, 319, 338, 344, 346, 347, 363,
2481	366, 367, 400-414, 473, or 492; or
2482	4.  Any combination of the above discharges.
2483	(b)  The hospital restricts its medical and surgical
2484	services to primarily or exclusively cardiac, orthopedic,
2485	surgical, or oncology specialties.
2486	(9)(10)  A hospital licensed as of June 1, 2004, shall be
2487	exempt from subsection (8) (9) as long as the hospital maintains
2488	the same ownership, facility street address, and range of
2489	services that were in existence on June 1, 2004. Any transfer of
2490	beds, or other agreements that result in the establishment of a
2491	hospital or hospital services within the intent of this section,
2492	shall be subject to subsection (8) (9). Unless the hospital is
2493	otherwise exempt under subsection (8) (9), the agency shall deny
2494	or revoke the license of a hospital that violates any of the
2495	criteria set forth in that subsection.
2496	(10)(11)  The agency may adopt rules implementing the
2497	licensure requirements set forth in subsection (8) (9). Within
2498	14 days after rendering its decision on a license application or
2499	revocation, the agency shall publish its proposed decision in
2500	the Florida Administrative Weekly. Within 21 days after
2501	publication of the agency's decision, any authorized person may
2502	file a request for an administrative hearing. In administrative
2503	proceedings challenging the approval, denial, or revocation of a
2504	license pursuant to subsection (8) (9), the hearing must be
2505	based on the facts and law existing at the time of the agency's
2506	proposed agency action. Existing hospitals may initiate or
2507	intervene in an administrative hearing to approve, deny, or
2508	revoke licensure under subsection (8) (9) based upon a showing
2509	that an established program will be substantially affected by
2510	the issuance or renewal of a license to a hospital within the
2511	same district or service area.
2512	Section 46.  Section 395.004, Florida Statutes, is amended
2513	to read:
2514	395.004  Application for license, fees; expenses.--
2515	(1)  In accordance with s. 408.805, an applicant or
2516	licensee shall pay a fee for each license application submitted
2517	under this part, part II of chapter 408, and applicable rules.
2518	The amount of the fee shall be established by rule. An
2519	application for a license or renewal thereof shall be made under
2520	oath to the agency, upon forms provided by it, and shall contain
2521	such information as the agency reasonably requires, which may
2522	include affirmative evidence of ability to comply with
2523	applicable laws and rules.
2524	(2)  Each application for a general hospital license,
2525	specialty hospital license, ambulatory surgical center license,
2526	or mobile surgical facility license, or renewal thereof, shall
2527	be accompanied by a license fee, in accordance with the
2528	following schedule:
2529	(a)  The biennial license, provisional license, and license
2530	renewal fee required of a facility licensed under this part
2531	shall be reasonably calculated to cover the cost of regulation
2532	under this part and shall be established by rule at the rate of
2533	not less than $9.50 per hospital bed, nor more than $30 per
2534	hospital bed, except that the minimum license fee shall be
2535	$1,500 and the total fees collected from all licensed facilities
2536	may not exceed the cost of properly carrying out the provisions
2537	of this part.
2538	(b)  Such fees shall be paid to the agency and shall be
2539	deposited in the Planning and Regulation Trust Fund of the
2540	agency, which is hereby created, for the sole purpose of
2541	carrying out the provisions of this part.
2542	Section 47.  Section 395.0055, Florida Statutes, is
2543	repealed.
2544	Section 48.  Section 395.0161, Florida Statutes, is amended
2545	to read:
2546	395.0161  Licensure inspection.--
2547	(1)  In accordance with s. 408.811, the agency shall make
2548	or cause to be made such inspections and investigations as it
2549	deems necessary, including:
2550	(a)  Inspections directed by the Health Care Financing
2551	Administration.
2552	(b)  Validation inspections.
2553	(c)  Lifesafety inspections.
2554	(d)  Licensure complaint investigations, including full
2555	licensure investigations with a review of all licensure
2556	standards as outlined in the administrative rules. Complaints
2557	received by the agency from individuals, organizations, or other
2558	sources are subject to review and investigation by the agency.
2559	(e)  Emergency access complaint investigations.
2560	(f)  inspections of mobile surgical facilities at each time
2561	a facility establishes a new location, prior to the admission of
2562	patients. However, such inspections shall not be required when a
2563	mobile surgical facility is moved temporarily to a location
2564	where medical treatment will not be provided.
2565	(2)  The agency shall accept, in lieu of its own periodic
2566	inspections for licensure, the survey or inspection of an
2567	accrediting organization, provided the accreditation of the
2568	licensed facility is not provisional and provided the licensed
2569	facility authorizes release of, and the agency receives the
2570	report of, the accrediting organization. The agency shall
2571	develop, and adopt by rule, criteria for accepting survey
2572	reports of accrediting organizations in lieu of conducting a
2573	state licensure inspection.
2574	(3)  In accordance with s. 408.805, an applicant or
2575	licensee shall pay a fee for each license application submitted
2576	under this part, part II of chapter 408, and applicable rules.
2577	With the exception of state-operated licensed facilities, each
2578	facility licensed under this part shall pay to the agency, at
2579	the time of inspection, the following fees:
2580	(a)  Inspection for licensure.--A fee shall be paid which
2581	is not less than $8 per hospital bed, nor more than $12 per
2582	hospital bed, except that the minimum fee shall be $400 per
2583	facility.
2584	(b)  Inspection for lifesafety only.--A fee shall be paid
2585	which is not less than 75 cents per hospital bed, nor more than
2586	$1.50 per hospital bed, except that the minimum fee shall be $40
2587	per facility.
2588	(4)  The agency shall coordinate all periodic inspections
2589	for licensure made by the agency to ensure that the cost to the
2590	facility of such inspections and the disruption of services by
2591	such inspections is minimized.
2592	Section 49.  Section 395.0162, Florida Statutes, is
2593	repealed.
2594	Section 50.  A licensee that failed to renew its ambulatory
2595	surgical center license may meet requirements of the Florida
2596	Building Code that were in effect at the time of original
2597	licensure for the purposes of an initial application if:
2598	(a)  The license expired between July 1, 2004, and December
2599	31, 2004.
2600	(b)  The initial license application was filed within 30
2601	days after the license expiration.
2602	(c)  The ambulatory surgical center is in compliance with
2603	regulatory requirements based upon agency inspection.
2604
2605	This section only applies to the initial application for
2606	licensure and does not circumvent any requirement to meet
2607	current Florida Building Code requirements for renovations or
2608	other modifications.
2609	Section 51.  Subsections (2) and (3) of section 395.0163,
2610	Florida Statutes, are amended to read:
2611	395.0163  Construction inspections; plan submission and
2612	approval; fees.--
2613	(2)(a)  The agency is authorized to charge an initial fee
2614	of $2,000 for review of plans and construction on all projects,
2615	no part of which is refundable. The agency may also collect a
2616	fee, not to exceed 1 percent of the estimated construction cost
2617	or the actual cost of review, whichever is less, for the portion
2618	of the review which encompasses initial review through the
2619	initial revised construction document review. The agency is
2620	further authorized to collect its actual costs on all subsequent
2621	portions of the review and construction inspections. The initial
2622	fee payment shall accompany the initial submission of plans and
2623	specifications. Any subsequent payment that is due is payable
2624	upon receipt of the invoice from the agency.
2625	(b)  Notwithstanding any other provisions of law to the
2626	contrary, all moneys received by the agency pursuant to the
2627	provisions of this section shall be deposited in the Planning
2628	and Regulation Trust Fund, as created by s. 395.004, to be held
2629	and applied solely for the operations required under this
2630	section.
2631	(3)  In accordance with s. 408.811, the agency shall
2632	inspect a mobile surgical facility at initial licensure and at
2633	each time the facility establishes a new location, prior to
2634	admission of patients. However, such inspections shall not be
2635	required when a mobile surgical facility is moved temporarily to
2636	a location where medical treatment will not be provided.
2637	Section 52.  Paragraph (c) of subsection (2) of section
2638	395.0191, Florida Statutes, is redesignated as paragraph (d),
2639	and a new paragraph (c) is added to said subsection, to read:
2640	395.0191  Staff membership and clinical privileges.--
2641	(2)
2642	(c)  A registered nurse licensed under part I of chapter
2643	464 and qualified by training and experience in perioperative
2644	nursing as defined in s. 464.027(2)(a) shall be present in the
2645	operating room and function as the circulating nurse during all
2646	operative, surgical, or invasive procedures.
2647	Section 53.  Subsections (4) and (6) of section 395.0193,
2648	Florida Statutes, are amended to read:
2649	395.0193  Licensed facilities; peer review; disciplinary
2650	powers; agency or partnership with physicians.--
2651	(4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
2652	actions taken under subsection (3) shall be reported in writing
2653	to the Department of Health Division of Health Quality Assurance
2654	of the agency within 30 working days after its initial
2655	occurrence, regardless of the pendency of appeals to the
2656	governing board of the hospital. The notification shall identify
2657	the disciplined practitioner, the action taken, and the reason
2658	for such action. All final disciplinary actions taken under
2659	subsection (3), if different from those which were reported to
2660	the department agency within 30 days after the initial
2661	occurrence, shall be reported within 10 working days to the
2662	Department of Health Division of Health Quality Assurance of the
2663	agency in writing and shall specify the disciplinary action
2664	taken and the specific grounds therefor. Final disciplinary
2665	actions shall be reported monthly to the Division of Health
2666	Quality Assurance of the agency. The division shall review each
2667	report and determine whether it potentially involved conduct by
2668	the licensee that is subject to disciplinary action, in which
2669	case s. 456.073 shall apply. The reports are not subject to
2670	inspection under s. 119.07(1) even if the division's
2671	investigation results in a finding of probable cause.
2672	(6)  For a single incident or series of isolated incidents
2673	that are nonwillful violations of the reporting requirements of
2674	this section, the agency shall first seek to obtain corrective
2675	action by the facility. If correction is not demonstrated within
2676	the timeframe established by the agency or if there is a pattern
2677	of nonwillful violations of this section, the agency may impose
2678	an administrative fine, not to exceed $5,000 for any violation
2679	of the reporting requirements of this section. The
2680	administrative fine for repeated nonwillful violations shall not
2681	exceed $10,000 for any violation. The administrative fine for
2682	each intentional and willful violation may not exceed $25,000
2683	per violation, per day. The fine for an intentional and willful
2684	violation of this section may not exceed $250,000. In
2685	determining the amount of fine to be levied, the agency shall be
2686	guided by s. 395.1065(1)(2)(b).
2687	Section 54.  Subsection (12) of section 395.0197, Florida
2688	Statutes, is amended to read:
2689	395.0197  Internal risk management program.--
2690	(12)  In addition to any penalty imposed pursuant to this
2691	section, the agency shall require a written plan of correction
2692	from the facility. For a single incident or series of isolated
2693	incidents that are nonwillful violations of the reporting
2694	requirements of this section, the agency shall first seek to
2695	obtain corrective action by the facility. If the correction is
2696	not demonstrated within the timeframe established by the agency
2697	or if there is a pattern of nonwillful violations of this
2698	section, the agency may impose an administrative fine, not to
2699	exceed $5,000 for any violation of the reporting requirements of
2700	this section. The administrative fine for repeated nonwillful
2701	violations shall not exceed $10,000 for any violation. The
2702	administrative fine for each intentional and willful violation
2703	may not exceed $25,000 per violation, per day. The fine for an
2704	intentional and willful violation of this section may not exceed
2705	$250,000. In determining the amount of fine to be levied, the
2706	agency shall be guided by s. 395.1065(1)(2)(b).
2707	Section 55.  Section 395.0199, Florida Statutes, is amended
2708	to read:
2709	395.0199  Private utilization review.--
2710	(1)  The purpose of this section is to:
2711	(a)  Promote the delivery of quality health care in a cost-
2712	effective manner.
2713	(b)  Foster greater coordination between providers and
2714	health insurers performing utilization review.
2715	(c)  Protect patients and insurance providers by ensuring
2716	that private review agents are qualified to perform utilization
2717	review activities and to make informed decisions on the
2718	appropriateness of medical care.
2719	(d)  This section does not regulate the activities of
2720	private review agents, health insurers, health maintenance
2721	organizations, or hospitals, except as expressly provided
2722	herein, or authorize regulation or intervention as to the
2723	correctness of utilization review decisions of insurers or
2724	private review agents.
2725	(2)  The requirements of part II of chapter 408 shall apply
2726	to the provision of services that require registration or
2727	licensure pursuant to this section and part II of chapter 408
2728	and to persons registered by or applying for such registration
2729	from the Agency for Health Care Administration pursuant to this
2730	section. However, each applicant for registration and registrant
2731	is exempt from the provisions of ss. 408.806(1)(e)2.,
2732	408.810(5)-(10), and 408.811. A private review agent conducting
2733	utilization review as to health care services performed or
2734	proposed to be performed in this state shall register with the
2735	agency in accordance with this section.
2736	(3)  In accordance with s. 408.805, an applicant for
2737	registration or registrant shall pay a fee for each registration
2738	application submitted under this section, part II of chapter
2739	408, and applicable rules. The amount of the fee shall be
2740	established by rule Registration shall be made annually with the
2741	agency on forms furnished by the agency and shall be accompanied
2742	by the appropriate registration fee as set by the agency. The
2743	fee and shall be sufficient to pay for the administrative costs
2744	of registering the agent, but shall not exceed $250. The agency
2745	may also charge reasonable fees, reflecting actual costs, to
2746	persons requesting copies of registration.
2747	(4)  Each applicant for registration must comply with the
2748	following requirements:
2749	(a)  Upon receipt of a completed, signed, and dated
2750	application, the agency shall require background screening, in
2751	accordance with the level 2 standards for screening set forth in
2752	chapter 435, of the managing employee or other similarly titled
2753	individual who is responsible for the operation of the entity.
2754	The applicant must comply with the procedures for level 2
2755	background screening as set forth in chapter 435, as well as the
2756	requirements of s. 435.03(3).
2757	(b)  The agency may require background screening of any
2758	other individual who is an applicant, if the agency has probable
2759	cause to believe that he or she has been convicted of a crime or
2760	has committed any other offense prohibited under the level 2
2761	standards for screening set forth in chapter 435.
2762	(c)  Proof of compliance with the level 2 background
2763	screening requirements of chapter 435 which has been submitted
2764	within the previous 5 years in compliance with any other health
2765	care licensure requirements of this state is acceptable in
2766	fulfillment of the requirements of paragraph (a).
2767	(d)  A provisional registration may be granted to an
2768	applicant when each individual required by this section to
2769	undergo background screening has met the standards for the
2770	Department of Law Enforcement background check, but the agency
2771	has not yet received background screening results from the
2772	Federal Bureau of Investigation, or a request for a
2773	disqualification exemption has been submitted to the agency as
2774	set forth in chapter 435 but a response has not yet been issued.
2775	A standard registration may be granted to the applicant upon the
2776	agency's receipt of a report of the results of the Federal
2777	Bureau of Investigation background screening for each individual
2778	required by this section to undergo background screening which
2779	confirms that all standards have been met, or upon the granting
2780	of a disqualification exemption by the agency as set forth in
2781	chapter 435. Any other person who is required to undergo level 2
2782	background screening may serve in his or her capacity pending
2783	the agency's receipt of the report from the Federal Bureau of
2784	Investigation. However, the person may not continue to serve if
2785	the report indicates any violation of background screening
2786	standards and a disqualification exemption has not been
2787	requested of and granted by the agency as set forth in chapter
2788	435.
2789	(e)  Each applicant must submit to the agency, with its
2790	application, a description and explanation of any exclusions,
2791	permanent suspensions, or terminations of the applicant from the
2792	Medicare or Medicaid programs. Proof of compliance with the
2793	requirements for disclosure of ownership and control interests
2794	under the Medicaid or Medicare programs shall be accepted in
2795	lieu of this submission.
2796	(f)  Each applicant must submit to the agency a description
2797	and explanation of any conviction of an offense prohibited under
2798	the level 2 standards of chapter 435 by a member of the board of
2799	directors of the applicant, its officers, or any individual
2800	owning 5 percent or more of the applicant. This requirement does
2801	not apply to a director of a not-for-profit corporation or
2802	organization if the director serves solely in a voluntary
2803	capacity for the corporation or organization, does not regularly
2804	take part in the day-to-day operational decisions of the
2805	corporation or organization, receives no remuneration for his or
2806	her services on the corporation or organization's board of
2807	directors, and has no financial interest and has no family
2808	members with a financial interest in the corporation or
2809	organization, provided that the director and the not-for-profit
2810	corporation or organization include in the application a
2811	statement affirming that the director's relationship to the
2812	corporation satisfies the requirements of this paragraph.
2813	(g)  A registration may not be granted to an applicant if
2814	the applicant or managing employee has been found guilty of,
2815	regardless of adjudication, or has entered a plea of nolo
2816	contendere or guilty to, any offense prohibited under the level
2817	2 standards for screening set forth in chapter 435, unless an
2818	exemption from disqualification has been granted by the agency
2819	as set forth in chapter 435.
2820	(h)  The agency may deny or revoke the registration if any
2821	applicant:
2822	1.  Has falsely represented a material fact in the
2823	application required by paragraph (e) or paragraph (f), or has
2824	omitted any material fact from the application required by
2825	paragraph (e) or paragraph (f); or
2826	2.  Has had prior action taken against the applicant under
2827	the Medicaid or Medicare program as set forth in paragraph (e).
2828	(i)  An application for registration renewal must contain
2829	the information required under paragraphs (e) and (f).
2830	(4)(5)  Registration shall include the following:
2831	(a)  A description of the review policies and procedures to
2832	be used in evaluating proposed or delivered hospital care.
2833	(b)  The name, address, and telephone number of the
2834	utilization review agent performing utilization review, who
2835	shall be at least:
2836	1.  A licensed practical nurse or licensed registered
2837	nurse, or other similarly qualified medical records or health
2838	care professionals, for performing initial review when
2839	information is necessary from the physician or hospital to
2840	determine the medical necessity or appropriateness of hospital
2841	services; or
2842	2.  A licensed physician, or a licensed physician
2843	practicing in the field of psychiatry for review of mental
2844	health services, for an initial denial determination prior to a
2845	final denial determination by the health insurer and which shall
2846	include the written evaluation and findings of the reviewing
2847	physician.
2848	(c)  A description of an appeal procedure for patients or
2849	health care providers whose services are under review, who may
2850	appeal an initial denial determination prior to a final
2851	determination by the health insurer with whom the private review
2852	agent has contracted. The appeal procedure shall provide for
2853	review by a licensed physician, or by a licensed physician
2854	practicing in the field of psychiatry for review of mental
2855	health services, and shall include the written evaluation and
2856	findings of the reviewing physician.
2857	(d)  A designation of the times when the staff of the
2858	utilization review agent will be available by toll-free
2859	telephone, which shall include at least 40 hours per week during
2860	the normal business hours of the agent.
2861	(e)  An acknowledgment and agreement that any private
2862	review agent which, as a general business practice, fails to
2863	adhere to the policies, procedures, and representations made in
2864	its application for registration shall have its registration
2865	revoked.
2866	(f)  Disclosure of any incentive payment provision or quota
2867	provision which is contained in the agent's contract with a
2868	health insurer and is based on reduction or denial of services,
2869	reduction of length of stay, or selection of treatment setting.
2870	(g)  Updates of any material changes to review policies or
2871	procedures.
2872	(6)  The agency may impose fines or suspend or revoke the
2873	registration of any private review agent in violation of this
2874	section. Any private review agent failing to register or update
2875	registration as required by this section shall be deemed to be
2876	within the jurisdiction of the agency and subject to an
2877	administrative penalty not to exceed $1,000. The agency may
2878	bring actions to enjoin activities of private review agents in
2879	violation of this section.
2880	(5)(7)  No insurer shall knowingly contract with or utilize
2881	a private review agent which has failed to register as required
2882	by this section or which has had a registration revoked by the
2883	agency.
2884	(6)(8)  A private review agent which operates under
2885	contract with the federal or state government for utilization
2886	review of patients eligible for hospital or other services under
2887	Title XVIII or Title XIX of the Social Security Act is exempt
2888	from the provisions of this section for services provided under
2889	such contract. A private review agent which provides utilization
2890	review services to the federal or state government and a private
2891	insurer shall not be exempt for services provided to
2892	nonfederally funded patients. This section shall not apply to
2893	persons who perform utilization review services for medically
2894	necessary hospital services provided to injured workers pursuant
2895	to chapter 440 and shall not apply to self-insurance funds or
2896	service companies authorized pursuant to chapter 440 or part VII
2897	of chapter 626.
2898	(7)(9)  Facilities licensed under this chapter shall
2899	promptly comply with the requests of utilization review agents
2900	or insurers which are reasonably necessary to facilitate prompt
2901	accomplishment of utilization review activities.
2902	(8)(10)  The agency shall adopt rules to implement the
2903	provisions of this section.
2904	Section 56.  Section 395.1046, Florida Statutes, is amended
2905	to read:
2906	395.1046  Complaint investigation procedures.--
2907	(1)  In accordance with s. 408.811, the agency shall
2908	investigate any complaint against a hospital for any violation
2909	of s. 395.1041 that the agency reasonably believes to be legally
2910	sufficient. A complaint is legally sufficient if it contains
2911	ultimate facts that which show that a violation of this section
2912	chapter, or any rule adopted under this chapter by the agency
2913	under this section, has occurred. The agency may investigate, or
2914	continue to investigate, and may take appropriate final action
2915	on a complaint, even though the original complainant withdraws
2916	his or her complaint or otherwise indicates his or her desire
2917	not to cause it to be investigated to completion. When an
2918	investigation of any person or facility is undertaken, the
2919	agency shall notify such person in writing of the investigation
2920	and inform the person or facility in writing of the substance,
2921	the facts which show that a violation has occurred, and the
2922	source of any complaint filed against him or her. The agency may
2923	conduct an investigation without notification to any person if
2924	the act under investigation is a criminal offense. The agency
2925	shall have access to all records necessary for the investigation
2926	of the complaint.
2927	(2)  The agency or its agent shall expeditiously
2928	investigate each complaint against a hospital for a violation of
2929	s. 395.1041. When its investigation is complete, the agency
2930	shall prepare an investigative report. The report shall contain
2931	the investigative findings and the recommendations of the agency
2932	concerning the existence of probable cause.
2933	(3)  The complaint and all information obtained by the
2934	agency during an investigation conducted pursuant to this
2935	section are exempt from the provisions of s. 119.07(1) and s.
2936	24(a), Art. I of the State Constitution until 10 days after the
2937	facility has been determined by the agency to be out of
2938	compliance with regulatory requirements probable cause has been
2939	found to exist by the agency, or until the person who is the
2940	subject of the investigation waives his or her privilege of
2941	confidentiality, whichever occurs first. In cases where the
2942	agency finds that the complaint is either not legally sufficient
2943	or does not demonstrate the facility's noncompliance with
2944	regulatory requirements when the agency determines that no
2945	probable cause exists, all records pertaining thereto are
2946	confidential and exempt from the provisions of s. 119.07(1) and
2947	s. 24(a), Art. I of the State Constitution. However, the
2948	complaint and a summary of the agency's findings shall be
2949	available, although information therein identifying an
2950	individual shall not be disclosed.
2951	Section 57.  Subsections (1) and (7) of section 395.1055,
2952	Florida Statutes, are amended to read:
2953	395.1055  Rules and enforcement.--
2954	(1)  The agency shall adopt rules pursuant to ss.
2955	120.536(1) and 120.54 to implement the provisions of this part
2956	and part II of chapter 408, which shall include reasonable and
2957	fair minimum standards for ensuring that:
2958	(a)  Sufficient numbers and qualified types of personnel
2959	and occupational disciplines are on duty and available at all
2960	times to provide necessary and adequate patient care and safety.
2961	(b)  Infection control, housekeeping, sanitary conditions,
2962	and medical record procedures that will adequately protect
2963	patient care and safety are established and implemented.
2964	(c)  A comprehensive emergency management plan is prepared
2965	and updated annually. Such standards must be included in the
2966	rules adopted by the agency after consulting with the Department
2967	of Community Affairs. At a minimum, the rules must provide for
2968	plan components that address emergency evacuation
2969	transportation; adequate sheltering arrangements; postdisaster
2970	activities, including emergency power, food, and water;
2971	postdisaster transportation; supplies; staffing; emergency
2972	equipment; individual identification of residents and transfer
2973	of records, and responding to family inquiries. The
2974	comprehensive emergency management plan is subject to review and
2975	approval by the local emergency management agency. During its
2976	review, the local emergency management agency shall ensure that
2977	the following agencies, at a minimum, are given the opportunity
2978	to review the plan: the Department of Elderly Affairs, the
2979	Department of Health, the Agency for Health Care Administration,
2980	and the Department of Community Affairs. Also, appropriate
2981	volunteer organizations must be given the opportunity to review
2982	the plan. The local emergency management agency shall complete
2983	its review within 60 days and either approve the plan or advise
2984	the facility of necessary revisions.
2985	(d)  Licensed facilities are established, organized, and
2986	operated consistent with established standards and rules.
2987	(e)  Licensed facility beds conform to minimum space,
2988	equipment, and furnishings standards as specified by the
2989	department.
2990	(f)  All hospitals submit such data as necessary to conduct
2991	certificate-of-need reviews required under part I of chapter 408
2992	ss. 408.031-408.045. Such data shall include, but shall not be
2993	limited to, patient origin data, hospital utilization data, type
2994	of service reporting, and facility staffing data. The agency
2995	shall not collect data that identifies or could disclose the
2996	identity of individual patients. The agency shall utilize
2997	existing uniform statewide data sources when available and shall
2998	minimize reporting costs to hospitals.
2999	(g)  Each hospital has a quality improvement program
3000	designed according to standards established by their current
3001	accrediting organization. This program will enhance quality of
3002	care and emphasize quality patient outcomes, corrective action
3003	for problems, governing board review, and reporting to the
3004	agency of standardized data elements necessary to analyze
3005	quality of care outcomes. The agency shall use existing data,
3006	when available, and shall not duplicate the efforts of other
3007	state agencies in order to obtain such data.
3008	(h)  Licensed facilities make available on their Internet
3009	websites, no later than October 1, 2004, and in a hard copy
3010	format upon request, a description of and a link to the patient
3011	charge and performance outcome data collected from licensed
3012	facilities pursuant to s. 408.061.
3013	(7)  The agency shall enforce compliance with the
3014	provisions of s. 381.005(2) and rules adopted thereunder with
3015	respect to immunizations against the influenza virus and
3016	pneumococcal bacteria. Any licensed facility which is in
3017	operation at the time of promulgation of any applicable rules
3018	under this part shall be given a reasonable time, under the
3019	particular circumstances, but not to exceed 1 year from the date
3020	of such promulgation, within which to comply with such rules.
3021	Section 58.  Section 395.1065, Florida Statutes, is amended
3022	to read:
3023	395.1065  Criminal and Administrative penalties;
3024	injunctions; emergency orders; moratorium.--
3025	(1)  Any person establishing, conducting, managing, or
3026	operating any facility without a license under this part is
3027	guilty of a misdemeanor and, upon conviction, shall be fined not
3028	more than $500 for the first offense and not more than $1,000
3029	for each subsequent offense, and each day of continuing
3030	violation after conviction shall be considered a separate
3031	offense.
3032	(1)(2)(a)  The agency may deny, revoke, or suspend a
3033	license or impose an administrative fine, not to exceed $1,000
3034	per violation, per day, for the violation of any provision of
3035	this part, part II of chapter 408, or applicable rules adopted
3036	under this part. Each day of violation constitutes a separate
3037	violation and is subject to a separate fine.
3038	(b)  In determining the amount of fine to be levied for a
3039	violation, as provided in paragraph (a), the following factors
3040	shall be considered:
3041	1.  The severity of the violation, including the
3042	probability that death or serious harm to the health or safety
3043	of any person will result or has resulted, the severity of the
3044	actual or potential harm, and the extent to which the provisions
3045	of this part were violated.
3046	2.  Actions taken by the licensee to correct the violations
3047	or to remedy complaints.
3048	3.  Any previous violations of the licensee.
3049	(c)  All amounts collected pursuant to this section shall
3050	be deposited into the Planning and Regulation Trust Fund, as
3051	created by s. 395.004.
3052	(c)(d)  The agency may impose an administrative fine for
3053	the violation of s. 641.3154 or, if sufficient claims due to a
3054	provider from a health maintenance organization do not exist to
3055	enable the take-back of an overpayment, as provided under s.
3056	641.3155(5), for the violation of s. 641.3155(5). The
3057	administrative fine for a violation cited in this paragraph
3058	shall be in the amounts specified in s. 641.52(5), and the
3059	provisions of paragraph (a) do not apply.
3060	(2)(3)  Notwithstanding the existence or pursuit of any
3061	other remedy, the agency may maintain an action in the name of
3062	the state for injunction or other process to enforce the
3063	provisions of this part, part II of chapter 408, and applicable
3064	rules promulgated hereunder.
3065	(4)  The agency may issue an emergency order immediately
3066	suspending or revoking a license when it determines that any
3067	condition in the licensed facility presents a clear and present
3068	danger to public health and safety.
3069	(5)  The agency may impose an immediate moratorium on
3070	elective admissions to any licensed facility, building, or
3071	portion thereof, or service, when the agency determines that any
3072	condition in the facility presents a threat to public health or
3073	safety.
3074	(3)(6)  In seeking to impose penalties against a facility
3075	as defined in s. 394.455 for a violation of part I of chapter
3076	394, the agency is authorized to rely on the investigation and
3077	findings by the Department of Health in lieu of conducting its
3078	own investigation.
3079	(4)(7)  The agency shall impose a fine of $500 for each
3080	instance of the facility's failure to provide the information
3081	required by rules adopted pursuant to s. 395.1055(1)(h).
3082	Section 59.  Subsection (1) of section 395.10973, Florida
3083	Statutes, is amended to read:
3084	395.10973  Powers and duties of the agency.--It is the
3085	function of the agency to:
3086	(1)  Adopt rules pursuant to ss. 120.536(1) and 120.54 to
3087	implement the provisions of this part and part II of chapter 408
3088	conferring duties upon it.
3089	Section 60.  Section 395.10974, Florida Statutes, is
3090	amended to read:
3091	395.10974  Health care risk managers; qualifications,
3092	licensure, fees.--
3093	(1)  The requirements of part II of chapter 408 shall apply
3094	to the provision of services that require licensure pursuant to
3095	ss. 395.10971?395.10976 and part II of chapter 408 and to
3096	entities licensed by or applying for such licensure from the
3097	Agency for Health Care Administration pursuant to ss. 395.10971?
3098	395.10976. Any person desiring to be licensed as a health care
3099	risk manager shall submit an application on a form provided by
3100	the agency. In order to qualify for licensure, the applicant
3101	shall submit evidence satisfactory to the agency that which
3102	demonstrates the applicant's competence, by education or
3103	experience, in the following areas:
3104	(a)  Applicable standards of health care risk management.
3105	(b)  Applicable federal, state, and local health and safety
3106	laws and rules.
3107	(c)  General risk management administration.
3108	(d)  Patient care.
3109	(e)  Medical care.
3110	(f)  Personal and social care.
3111	(g)  Accident prevention.
3112	(h)  Departmental organization and management.
3113	(i)  Community interrelationships.
3114	(j)  Medical terminology.
3115
3116	Each applicant for licensure and licensee must comply with all
3117	provisions of part II of chapter 408 except ss. 408.806(1)(e)2.,
3118	408.810, and 408.811. The agency may require such additional
3119	information, from the applicant or any other person, as may be
3120	reasonably required to verify the information contained in the
3121	application.
3122	(2)  The agency shall not grant or issue a license as a
3123	health care risk manager to any individual unless from the
3124	application it affirmatively appears that the applicant:
3125	(a)  Is 18 years of age or over;
3126	(b)  Is a high school graduate or equivalent; and
3127	(c)1.  Has fulfilled the requirements of a 1-year program
3128	or its equivalent in health care risk management training which
3129	may be developed or approved by the agency;
3130	2.  Has completed 2 years of college-level studies which
3131	would prepare the applicant for health care risk management, to
3132	be further defined by rule; or
3133	3.  Has obtained 1 year of practical experience in health
3134	care risk management.
3135	(3)  The agency shall issue a license to practice health
3136	care risk management to any applicant who qualifies under this
3137	section. In accordance with s. 408.805, an applicant or licensee
3138	shall pay a fee for each license application submitted under
3139	this part, part II of chapter 408, and applicable rules. The
3140	amount of the fee shall be established by rule as follows: and
3141	submits an application fee of not more than $75, a background
3142	screening fingerprinting fee of not more than $75, and a license
3143	fee of not more than $100. The agency shall by rule establish
3144	fees and procedures for the issuance and cancellation of
3145	licenses.
3146	(4)  The agency shall renew a health care risk manager
3147	license upon receipt of a biennial renewal application and fees.
3148	The agency shall by rule establish a procedure for the biennial
3149	renewal of licenses.
3150	Section 61.  Subsections (6) through (19) of section
3151	400.021, Florida Statutes, are renumbered as subsections (5)
3152	through (18), respectively, and present subsections (5) and (20)
3153	of said section are amended to read:
3154	400.021  Definitions.--When used in this part, unless the
3155	context otherwise requires, the term:
3156	(5)  "Controlling interest" means:
3157	(a)  The applicant for licensure or a licensee;
3158	(b)  A person or entity that serves as an officer of, is on
3159	the board of directors of, or has a 5 percent or greater
3160	ownership interest in the management company or other entity,
3161	related or unrelated, which the applicant or licensee may
3162	contract with to operate the facility; or
3163	(c)  A person or entity that serves as an officer of, is on
3164	the board of directors of, or has a 5 percent or greater
3165	ownership interest in the applicant or licensee.
3166
3167	The term does not include a voluntary board member.
3168	(20)  "Voluntary board member" means a director of a not-
3169	for-profit corporation or organization who serves solely in a
3170	voluntary capacity for the corporation or organization, does not
3171	receive any remuneration for his or her services on the board of
3172	directors, and has no financial interest in the corporation or
3173	organization. The agency shall recognize a person as a voluntary
3174	board member following submission of a statement to the agency
3175	by the director and the not-for-profit corporation or
3176	organization which affirms that the director conforms to this
3177	definition. The statement affirming the status of the director
3178	must be submitted to the agency on a form provided by the
3179	agency.
3180	Section 62.  Paragraph (c) of subsection (2) of section
3181	395.602, Florida Statutes, is amended to read:
3182	395.602  Rural hospitals.--
3183	(2)  DEFINITIONS.--As used in this part:
3184	(c)  "Inactive rural hospital bed" means a licensed acute
3185	care hospital bed, as defined in s. 395.002(13)(14), that is
3186	inactive in that it cannot be occupied by acute care inpatients.
3187	Section 63.  Paragraph (c) of subsection (1) of section
3188	395.701, Florida Statutes, is amended to read:
3189	395.701  Annual assessments on net operating revenues for
3190	inpatient and outpatient services to fund public medical
3191	assistance; administrative fines for failure to pay assessments
3192	when due; exemption.--
3193	(1)  For the purposes of this section, the term:
3194	(c)  "Hospital" means a health care institution as defined
3195	in s. 395.002(12)(13), but does not include any hospital
3196	operated by the agency or the Department of Corrections.
3197	Section 64.  Subsection (3) of section 400.022, Florida
3198	Statutes, is amended to read:
3199	400.022  Residents' rights.--
3200	(3)  Any violation of the resident's rights set forth in
3201	this section shall constitute grounds for action by the agency
3202	under the provisions of s. 400.102, s. 400.121, or part II of
3203	chapter 408. In order to determine whether the licensee is
3204	adequately protecting residents' rights, the licensure annual
3205	inspection of the facility shall include private informal
3206	conversations with a sample of residents to discuss residents'
3207	experiences within the facility with respect to rights specified
3208	in this section and general compliance with standards, and
3209	consultation with the ombudsman council in the local planning
3210	and service area of the Department of Elderly Affairs in which
3211	the nursing home is located.
3212	Section 65.  Paragraph (b) of subsection (1) of section
3213	400.051, Florida Statutes, is amended to read:
3214	400.051  Homes or institutions exempt from the provisions
3215	of this part.--
3216	(1)  The following shall be exempt from the provisions of
3217	this part:
3218	(b)  Any hospital, as defined in s. 395.002(11), that is
3219	licensed under chapter 395.
3220	Section 66.  Section 400.062, Florida Statutes, is amended
3221	to read:
3222	400.062  License required; fee; disposition; display;
3223	transfer.--
3224	(1)  The requirements of part II of chapter 408 shall apply
3225	to the provision of services that require licensure pursuant to
3226	this part and part II of chapter 408 and to entities licensed by
3227	or applying for such licensure from the Agency for Health Care
3228	Administration pursuant to this part. However, each applicant
3229	for licensure and each licensee is exempt from s. 408.810(7). It
3230	is unlawful to operate or maintain a facility without first
3231	obtaining from the agency a license authorizing such operation.
3232	(2)  Separate licenses shall be required for facilities
3233	maintained in separate premises, even though operated under the
3234	same management. However, a separate license shall not be
3235	required for separate buildings on the same grounds.
3236	(3)  In accordance with s. 408.805, an applicant or
3237	licensee shall pay a fee for each license application submitted
3238	under this part, part II of chapter 408, and applicable rules.
3239	The annual license fee required for each license issued under
3240	this part shall be comprised of two parts. Part I of the license
3241	fee shall be the basic license fee. The rate per bed for the
3242	basic license fee shall be established biennially annually and
3243	shall be $100 $50 per bed unless modified by rule. The agency
3244	may adjust the per bed licensure fees by the Consumer Price
3245	Index based on the 12 months immediately preceding the increase
3246	to cover the cost of regulation under this part. Part II of the
3247	license fee shall be the resident protection fee, which shall be
3248	at the rate of not less than 50 25 cents per bed. The rate per
3249	bed shall be the minimum rate per bed, and such rate shall
3250	remain in effect until the effective date of a rate per bed
3251	adopted by rule by the agency pursuant to this part. At such
3252	time as the amount on deposit in the Resident Protection Trust
3253	Fund is less than $1 million, the agency may adopt rules to
3254	establish a rate which may not exceed $20 $10 per bed. The rate
3255	per bed shall revert back to the minimum rate per bed when the
3256	amount on deposit in the Resident Protection Trust Fund reaches
3257	$1 million, except that any rate established by rule shall
3258	remain in effect until such time as the rate has been equally
3259	required for each license issued under this part. Any amount in
3260	the fund in excess of $2 million shall revert to the Health Care
3261	Trust Fund and may not be expended without prior approval of the
3262	Legislature. The agency may prorate the biennial annual license
3263	fee for those licenses which it issues under this part for less
3264	than 2 years 1 year. Funds generated by license fees collected
3265	in accordance with this section shall be deposited in the
3266	following manner:
3267	(a)  The basic license fee collected shall be deposited in
3268	the Health Care Trust Fund, established for the sole purpose of
3269	carrying out this part. When the balance of the account
3270	established in the Health Care Trust Fund for the deposit of
3271	fees collected as authorized under this section exceeds one-
3272	third of the annual cost of regulation under this part, the
3273	excess shall be used to reduce the licensure fees in the next
3274	year.
3275	(b)  The resident protection fee collected shall be
3276	deposited in the Resident Protection Trust Fund for the sole
3277	purpose of paying, in accordance with the provisions of s.
3278	400.063, for the appropriate alternate placement, care, and
3279	treatment of a resident removed from a nursing home facility on
3280	a temporary, emergency basis or for the maintenance and care of
3281	residents in a nursing home facility pending removal and
3282	alternate placement.
3283	(4)  Counties or municipalities applying for licenses under
3284	this part are exempt from license fees authorized under this
3285	section.
3286	(5)  The license shall be displayed in a conspicuous place
3287	inside the facility.
3288	(6)  A license shall be valid only in the hands of the
3289	individual, firm, partnership, association, or corporation to
3290	whom it is issued and shall not be subject to sale, assignment,
3291	or other transfer, voluntary or involuntary, nor shall a license
3292	be valid for any premises other than those for which originally
3293	issued.
3294	Section 67.  Subsection (1) of section 400.063, Florida
3295	Statutes, is amended to read:
3296	400.063  Resident Protection Trust Fund.--
3297	(1)  A Resident Protection Trust Fund shall be established
3298	for the purpose of collecting and disbursing funds generated
3299	from the license fees and administrative fines as provided for
3300	in ss. 393.0673(2), 400.062(3)(b), 400.111(1), 400.121(2), and
3301	400.23(8). Such funds shall be for the sole purpose of paying
3302	for the appropriate alternate placement, care, and treatment of
3303	residents who are removed from a facility licensed under this
3304	part or a facility specified in s. 393.0678(1) in which the
3305	agency determines that existing conditions or practices
3306	constitute an immediate danger to the health, safety, or
3307	security of the residents. If the agency determines that it is
3308	in the best interest of the health, safety, or security of the
3309	residents to provide for an orderly removal of the residents
3310	from the facility, the agency may utilize such funds to maintain
3311	and care for the residents in the facility pending removal and
3312	alternative placement. The maintenance and care of the residents
3313	shall be under the direction and control of a receiver appointed
3314	pursuant to s. 393.0678(1) or s. 400.126(1). However, funds may
3315	be expended in an emergency upon a filing of a petition for a
3316	receiver, upon the declaration of a state of local emergency
3317	pursuant to s. 252.38(3)(a)5., or upon a duly authorized local
3318	order of evacuation of a facility by emergency personnel to
3319	protect the health and safety of the residents.
3320	Section 68.  Section 400.071, Florida Statutes, is amended
3321	to read:
3322	400.071  Application for license.--
3323	(1)  An application for a license as required by s. 400.062
3324	shall be made to the agency on forms furnished by it and shall
3325	be accompanied by the appropriate license fee.
3326	(1)(2)  The application for a license shall be under oath
3327	and shall contain the following:
3328	(a)  The name, address, and social security number of the
3329	applicant if an individual; if the applicant is a firm,
3330	partnership, or association, its name, address, and employer
3331	identification number (EIN), and the name and address of any
3332	controlling interest; and the name by which the facility is to
3333	be known.
3334	(b)  The name of any person whose name is required on the
3335	application under the provisions of paragraph (a) and who owns
3336	at least a 10-percent interest in any professional service,
3337	firm, association, partnership, or corporation providing goods,
3338	leases, or services to the facility for which the application is
3339	made, and the name and address of the professional service,
3340	firm, association, partnership, or corporation in which such
3341	interest is held.
3342	(c)  The location of the facility for which a license is
3343	sought and an indication, as in the original application, that
3344	such location conforms to the local zoning ordinances.
3345	(d)  The name of the person or persons under whose
3346	management or supervision the facility will be conducted and the
3347	name of the administrator.
3348	(a)(e)  A signed affidavit disclosing any financial or
3349	ownership interest that a controlling interest as defined in
3350	part II of chapter 408 person or entity described in paragraph
3351	(a) or paragraph (d) has held in the last 5 years in any entity
3352	licensed by this state or any other state to provide health or
3353	residential care which has closed voluntarily or involuntarily;
3354	has filed for bankruptcy; has had a receiver appointed; has had
3355	a license denied, suspended, or revoked; or has had an
3356	injunction issued against it which was initiated by a regulatory
3357	agency. The affidavit must disclose the reason any such entity
3358	was closed, whether voluntarily or involuntarily.
3359	(b)(f)  The total number of beds and the total number of
3360	Medicare and Medicaid certified beds.
3361	(c)(g)  Information relating to the number, experience, and
3362	training of the employees of the facility and of the moral
3363	character of the applicant and employees that which the agency
3364	requires by rule, including the name and address of any nursing
3365	home with which the applicant or employees have been affiliated
3366	through ownership or employment within 5 years of the date of
3367	the application for a license and the record of any criminal
3368	convictions involving the applicant and any criminal convictions
3369	involving an employee if known by the applicant after inquiring
3370	of the employee. The applicant must demonstrate that sufficient
3371	numbers of qualified staff, by training or experience, will be
3372	employed to properly care for the type and number of residents
3373	who will reside in the facility.
3374	(d)(h)  Copies of any civil verdict or judgment involving
3375	the applicant rendered within the 10 years preceding the
3376	application, relating to medical negligence, violation of
3377	residents' rights, or wrongful death. As a condition of
3378	licensure, the licensee agrees to provide to the agency copies
3379	of any new verdict or judgment involving the applicant, relating
3380	to such matters, within 30 days after filing with the clerk of
3381	the court. The information required in this paragraph shall be
3382	maintained in the facility's licensure file and in an agency
3383	database which is available as a public record.
3384	(3)  The applicant shall submit evidence which establishes
3385	the good moral character of the applicant, manager, supervisor,
3386	and administrator. No applicant, if the applicant is an
3387	individual; no member of a board of directors or officer of an
3388	applicant, if the applicant is a firm, partnership, association,
3389	or corporation; and no licensed nursing home administrator shall
3390	have been convicted, or found guilty, regardless of
3391	adjudication, of a crime in any jurisdiction which affects or
3392	may potentially affect residents in the facility.
3393	(4)  Each applicant for licensure must comply with the
3394	following requirements:
3395	(a)  Upon receipt of a completed, signed, and dated
3396	application, the agency shall require background screening of
3397	the applicant, in accordance with the level 2 standards for
3398	screening set forth in chapter 435. As used in this subsection,
3399	the term "applicant" means the facility administrator, or
3400	similarly titled individual who is responsible for the day-to-
3401	day operation of the licensed facility, and the facility
3402	financial officer, or similarly titled individual who is
3403	responsible for the financial operation of the licensed
3404	facility.
3405	(b)  The agency may require background screening for a
3406	member of the board of directors of the licensee or an officer
3407	or an individual owning 5 percent or more of the licensee if the
3408	agency has probable cause to believe that such individual has
3409	been convicted of an offense prohibited under the level 2
3410	standards for screening set forth in chapter 435.
3411	(c)  Proof of compliance with the level 2 background
3412	screening requirements of chapter 435 which has been submitted
3413	within the previous 5 years in compliance with any other health
3414	care or assisted living licensure requirements of this state is
3415	acceptable in fulfillment of paragraph (a). Proof of compliance
3416	with background screening which has been submitted within the
3417	previous 5 years to fulfill the requirements of the Financial
3418	Services Commission and the Office of Insurance Regulation
3419	pursuant to chapter 651 as part of an application for a
3420	certificate of authority to operate a continuing care retirement
3421	community is acceptable in fulfillment of the Department of Law
3422	Enforcement and Federal Bureau of Investigation background
3423	check.
3424	(d)  A provisional license may be granted to an applicant
3425	when each individual required by this section to undergo
3426	background screening has met the standards for the Department of
3427	Law Enforcement background check, but the agency has not yet
3428	received background screening results from the Federal Bureau of
3429	Investigation, or a request for a disqualification exemption has
3430	been submitted to the agency as set forth in chapter 435, but a
3431	response has not yet been issued. A license may be granted to
3432	the applicant upon the agency's receipt of a report of the
3433	results of the Federal Bureau of Investigation background
3434	screening for each individual required by this section to
3435	undergo background screening which confirms that all standards
3436	have been met, or upon the granting of a disqualification
3437	exemption by the agency as set forth in chapter 435. Any other
3438	person who is required to undergo level 2 background screening
3439	may serve in his or her capacity pending the agency's receipt of
3440	the report from the Federal Bureau of Investigation; however,
3441	the person may not continue to serve if the report indicates any
3442	violation of background screening standards and a
3443	disqualification exemption has not been requested of and granted
3444	by the agency as set forth in chapter 435.
3445	(e)  Each applicant must submit to the agency, with its
3446	application, a description and explanation of any exclusions,
3447	permanent suspensions, or terminations of the applicant from the
3448	Medicare or Medicaid programs. Proof of compliance with
3449	disclosure of ownership and control interest requirements of the
3450	Medicaid or Medicare programs shall be accepted in lieu of this
3451	submission.
3452	(f)  Each applicant must submit to the agency a description
3453	and explanation of any conviction of an offense prohibited under
3454	the level 2 standards of chapter 435 by a member of the board of
3455	directors of the applicant, its officers, or any individual
3456	owning 5 percent or more of the applicant. This requirement
3457	shall not apply to a director of a not-for-profit corporation or
3458	organization if the director serves solely in a voluntary
3459	capacity for the corporation or organization, does not regularly
3460	take part in the day-to-day operational decisions of the
3461	corporation or organization, receives no remuneration for his or
3462	her services on the corporation or organization's board of
3463	directors, and has no financial interest and has no family
3464	members with a financial interest in the corporation or
3465	organization, provided that the director and the not-for-profit
3466	corporation or organization include in the application a
3467	statement affirming that the director's relationship to the
3468	corporation satisfies the requirements of this paragraph.
3469	(g)  An application for license renewal must contain the
3470	information required under paragraphs (e) and (f).
3471	(5)  The applicant shall furnish satisfactory proof of
3472	financial ability to operate and conduct the nursing home in
3473	accordance with the requirements of this part and all rules
3474	adopted under this part, and the agency shall establish
3475	standards for this purpose, including information reported under
3476	paragraph (2)(e). The agency also shall establish documentation
3477	requirements, to be completed by each applicant, that show
3478	anticipated facility revenues and expenditures, the basis for
3479	financing the anticipated cash-flow requirements of the
3480	facility, and an applicant's access to contingency financing.
3481	(6)  If the applicant offers continuing care agreements as
3482	defined in chapter 651, proof shall be furnished that such
3483	applicant has obtained a certificate of authority as required
3484	for operation under that chapter.
3485	(2)(7)  As a condition of licensure, each licensee, except
3486	one offering continuing care agreements as defined in chapter
3487	651, must agree to accept recipients of Title XIX of the Social
3488	Security Act on a temporary, emergency basis. The persons whom
3489	the agency may require such licensees to accept are those
3490	recipients of Title XIX of the Social Security Act who are
3491	residing in a facility in which existing conditions constitute
3492	an immediate danger to the health, safety, or security of the
3493	residents of the facility.
3494	(3)(8)  The agency may not issue a license to a nursing
3495	home that fails to receive a certificate of need under the
3496	provisions of ss. 408.031-408.045. It is the intent of the
3497	Legislature that, in reviewing a certificate-of-need application
3498	to add beds to an existing nursing home facility, preference be
3499	given to the application of a licensee who has been awarded a
3500	Gold Seal as provided for in s. 400.235, if the applicant
3501	otherwise meets the review criteria specified in s. 408.035.
3502	(4)(9)  The agency may develop an abbreviated survey for
3503	licensure renewal applicable to a licensee that has continuously
3504	operated as a nursing facility since 1991 or earlier, has
3505	operated under the same management for at least the preceding 30
3506	months, and has had during the preceding 30 months no class I or
3507	class II deficiencies.
3508	(5)(10)  As a condition of licensure, each facility must
3509	establish and submit with its application a plan for quality
3510	assurance and for conducting risk management.
3511	(11)  The applicant must provide the agency with proof of a
3512	legal right to occupy the property before a license may be
3513	issued. Proof may include, but is not limited to, copies of
3514	warranty deeds, lease or rental agreements, contracts for deeds,
3515	or quitclaim deeds.
3516	Section 69.  Subsection (4) of section 400.0712, Florida
3517	Statutes, is renumbered as subsection (3) and present subsection
3518	(3) of said section is amended to read:
3519	400.0712  Application for inactive license.--
3520	(3)  The agency may issue an inactive license to a nursing
3521	home that will be temporarily unable to provide services but is
3522	reasonably expected to resume services.
3523	(a)  An inactive license issued under this subsection may
3524	be issued for a period not to exceed 12 months and may be
3525	renewed by the agency for an additional 6 months upon
3526	demonstration of progress toward reopening.
3527	(b)  All licensure fees must be current and paid in full,
3528	and may be prorated as provided by agency rule, before the
3529	inactive license is issued.
3530	(c)  Reactivation of an inactive license requires that the
3531	applicant pay all licensure fees and be inspected by the agency
3532	to confirm that all of the requirements of this part and
3533	applicable rules are met.
3534	Section 70.  Section 400.102, Florida Statutes, is amended
3535	to read:
3536	400.102  Action by agency against licensee; grounds.--
3537	(1)  In addition to the grounds listed in part II of
3538	chapter 408, any of the following conditions shall be grounds
3539	for action by the agency against a licensee:
3540	(1)(a)  An intentional or negligent act materially
3541	affecting the health or safety of residents of the facility;
3542	(2)(b)  Misappropriation or conversion of the property of a
3543	resident of the facility;
3544	(3)(c)  Failure to follow the criteria and procedures
3545	provided under part I of chapter 394 relating to the
3546	transportation, voluntary admission, and involuntary examination
3547	of a nursing home resident; or
3548	(d)  Violation of provisions of this part or rules adopted
3549	under this part;
3550	(4)(e)  Fraudulent altering, defacing, or falsifying any
3551	medical or nursing home records, or causing or procuring any of
3552	these offenses to be committed.; or
3553	(f)  Any act constituting a ground upon which application
3554	for a license may be denied.
3555	(2)  If the agency has reasonable belief that any of such
3556	conditions exist, it shall take the following action:
3557	(a)  In the case of an applicant for original licensure,
3558	denial action as provided in s. 400.121.
3559	(b)  In the case of an applicant for relicensure or a
3560	current licensee, administrative action as provided in s.
3561	400.121 or injunctive action as authorized by s. 400.125.
3562	(c)  In the case of a facility operating without a license,
3563	injunctive action as authorized in s. 400.125.
3564	Section 71.  Section 400.111, Florida Statutes, is amended
3565	to read:
3566	400.111  Disclosure of controlling interest Expiration of
3567	license; renewal.--
3568	(1)  A license issued for the operation of a facility,
3569	unless sooner suspended or revoked, shall expire on the date set
3570	forth by the agency on the face of the license or 1 year from
3571	the date of issuance, whichever occurs first. Ninety days prior
3572	to the expiration date, an application for renewal shall be
3573	submitted to the agency. A license shall be renewed upon the
3574	filing of an application on forms furnished by the agency if the
3575	applicant has first met the requirements established under this
3576	part and all rules adopted under this part. The failure to file
3577	an application within the period established in this subsection
3578	shall result in a late fee charged to the licensee by the agency
3579	in an amount equal to 50 percent of the fee in effect on the
3580	last preceding regular renewal date. A late fee shall be levied
3581	for each and every day the filing of the license application is
3582	delayed, but in no event shall such fine aggregate more than
3583	$5,000. If an application is received after the required filing
3584	date and exhibits a hand-canceled postmark obtained from a
3585	United States Post Office dated on or before the required filing
3586	date, no fine will be levied.
3587	(2)  A licensee against whom a revocation or suspension
3588	proceeding, or any judicial proceeding instituted by the agency
3589	under this part, is pending at the time of license renewal may
3590	be issued a temporary license effective until final disposition
3591	by the agency of such proceeding. If judicial relief is sought
3592	from the aforesaid administrative order, the court having
3593	jurisdiction may issue such orders regarding the issuance of a
3594	temporary permit during the pendency of the judicial proceeding.
3595	(3)  The agency may not renew a license if the applicant
3596	has failed to pay any fines assessed by final order of the
3597	agency or final order of the Health Care Financing
3598	Administration under requirements for federal certification. The
3599	agency may renew the license of an applicant following the
3600	assessment of a fine by final order if such fine has been paid
3601	into an escrow account pending an appeal of a final order.
3602	(4)  In addition to the requirements of part II of chapter
3603	408, the licensee shall submit a signed affidavit disclosing any
3604	financial or ownership interest that a controlling interest
3605	licensee has held within the last 5 years in any entity licensed
3606	by the state or any other state to provide health or residential
3607	care which entity has closed voluntarily or involuntarily; has
3608	filed for bankruptcy; has had a receiver appointed; has had a
3609	license denied, suspended, or revoked; or has had an injunction
3610	issued against it which was initiated by a regulatory agency.
3611	The affidavit must disclose the reason such entity was closed,
3612	whether voluntarily or involuntarily.
3613	Section 72.  Subsections (2) and (5) of section 400.1183,
3614	Florida Statutes, are amended to read:
3615	400.1183  Resident grievance procedures.--
3616	(2)  Each facility shall maintain records of all grievances
3617	and shall report annually to the agency at the time of
3618	relicensure the total number of grievances handled during the
3619	prior licensure period, a categorization of the cases underlying
3620	the grievances, and the final disposition of the grievances.
3621	(5)  The agency may impose an administrative fine, in
3622	accordance with s. 400.121, against a nursing home facility for
3623	noncompliance with this section.
3624	Section 73.  Section 400.121, Florida Statutes, is amended
3625	to read:
3626	400.121  Denial, suspension, revocation of license;
3627	moratorium on admissions; administrative fines; procedure; order
3628	to increase staffing.--
3629	(1)  The agency may deny an application, revoke or suspend
3630	a license, and or impose an administrative fine, not to exceed
3631	$500 per violation per day for the violation of any provision of
3632	this part, part II of chapter 408, or applicable rules, against
3633	any applicant or licensee for the following violations by the
3634	applicant, licensee, or other controlling interest:
3635	(a)  A violation of any provision of this part, part II of
3636	chapter 408, or applicable rules s. 400.102(1); or
3637	(b)  A demonstrated pattern of deficient practice;
3638	(c)  Failure to pay any outstanding fines assessed by final
3639	order of the agency or final order of the Health Care Financing
3640	Administration pursuant to requirements for federal
3641	certification. The agency may renew or approve the license of an
3642	applicant following the assessment of a fine by final order if
3643	such fine has been paid into an escrow account pending an appeal
3644	of a final order;
3645	(d)  Exclusion from the Medicare or Medicaid program; or
3646	(b)(e)  An adverse action by a regulatory agency against
3647	any other licensed facility that has a common controlling
3648	interest with the licensee or applicant against whom the action
3649	under this section is being brought. If the adverse action
3650	involves solely the management company, the applicant or
3651	licensee shall be given 30 days to remedy before final action is
3652	taken. If the adverse action is based solely upon actions by a
3653	controlling interest, the applicant or licensee may present
3654	factors in mitigation of any proposed penalty based upon a
3655	showing that such penalty is inappropriate under the
3656	circumstances.
3657
3658	All hearings shall be held within the county in which the
3659	licensee or applicant operates or applies for a license to
3660	operate a facility as defined herein.
3661	(2)  Except as provided in s. 400.23(8), a $500 fine shall
3662	be imposed for each violation. Each day a violation of this part
3663	occurs constitutes a separate violation and is subject to a
3664	separate fine, but in no event may any fine aggregate more than
3665	$5,000. A fine may be levied pursuant to this section in lieu of
3666	and notwithstanding the provisions of s. 400.23. Fines paid
3667	shall be deposited in the Resident Protection Trust Fund and
3668	expended as provided in s. 400.063.
3669	(3)  The agency shall revoke or deny a nursing home license
3670	if the licensee or controlling interest operates a facility in
3671	this state that:
3672	(a)  Has had two moratoria imposed by final order for
3673	substandard quality of care, as defined by 42 C.F.R. part 483,
3674	within any 30-month period;
3675	(b)  Is conditionally licensed for 180 or more continuous
3676	days;
3677	(c)  Is cited for two class I deficiencies arising from
3678	unrelated circumstances during the same survey or investigation;
3679	or
3680	(d)  Is cited for two class I deficiencies arising from
3681	separate surveys or investigations within a 30-month period.
3682
3683	The licensee may present factors in mitigation of revocation,
3684	and the agency may make a determination not to revoke a license
3685	based upon a showing that revocation is inappropriate under the
3686	circumstances.
3687	(4)  The agency may issue an order immediately suspending
3688	or revoking a license when it determines that any condition in
3689	the facility presents a danger to the health, safety, or welfare
3690	of the residents in the facility.
3691	(5)(a)  The agency may impose an immediate moratorium on
3692	admissions to any facility when the agency determines that any
3693	condition in the facility presents a threat to the health,
3694	safety, or welfare of the residents in the facility.
3695	(4)(b)  Where the agency has placed a moratorium on
3696	admissions on any facility two times within a 7-year period, the
3697	agency may suspend the nursing home license of the nursing home
3698	and the facility's management company, if any. During the
3699	suspension, the agency shall take the facility into receivership
3700	and shall operate the facility.
3701	(5)(6)  An action taken by the agency to deny, suspend, or
3702	revoke a facility's license under this part shall be heard by
3703	the Division of Administrative Hearings of the Department of
3704	Management Services within 60 days after the assignment of an
3705	administrative law judge, unless the time limitation is waived
3706	by both parties. The administrative law judge must render a
3707	decision within 30 days after receipt of a proposed recommended
3708	order.
3709	(6)(7)  The agency is authorized to require a facility to
3710	increase staffing beyond the minimum required by law, if the
3711	agency has taken administrative action against the facility for
3712	care-related deficiencies directly attributable to insufficient
3713	staff. Under such circumstances, the facility may request an
3714	expedited interim rate increase. The agency shall process the
3715	request within 10 days after receipt of all required
3716	documentation from the facility. A facility that fails to
3717	maintain the required increased staffing is subject to a fine of
3718	$500 per day for each day the staffing is below the level
3719	required by the agency.
3720	(8)  An administrative proceeding challenging an action
3721	taken by the agency pursuant to this section shall be reviewed
3722	on the basis of the facts and conditions that resulted in such
3723	agency action.
3724	(7)(9)  Notwithstanding any other provision of law to the
3725	contrary, agency action in an administrative proceeding under
3726	this section may be overcome by the licensee upon a showing by a
3727	preponderance of the evidence to the contrary.
3728	(8)(10)  In addition to any other sanction imposed under
3729	this part, in any final order that imposes sanctions, the agency
3730	may assess costs related to the investigation and prosecution of
3731	the case. Payment of agency costs shall be deposited into the
3732	Health Care Trust Fund.
3733	Section 74.  Section 400.125, Florida Statutes, is
3734	repealed.
3735	Section 75.  Subsections (14), (15), and (16) of section
3736	400.141, Florida Statutes, are amended to read:
3737	400.141  Administration and management of nursing home
3738	facilities.--Every licensed facility shall comply with all
3739	applicable standards and rules of the agency and shall:
3740	(14)  Submit to the agency the information specified in s.
3741	400.071(1)(a)(2)(e) for a management company within 30 days
3742	after the effective date of the management agreement.
3743	(15)(a)  By the 15th calendar day of the month following
3744	the end of each calendar quarter, submit semiannually to the
3745	agency, or more frequently if requested by the agency,
3746	information regarding facility staff-to-resident ratios, staff
3747	turnover, and staff stability, including information regarding
3748	certified nursing assistants, licensed nurses, the director of
3749	nursing, and the facility administrator. For purposes of this
3750	reporting:
3751	1.(a)  Staff-to-resident ratios must be reported in the
3752	categories specified in s. 400.23(3)(a) and applicable rules.
3753	The ratio must be reported as an average for the most recent
3754	calendar quarter.
3755	2.(b)  Staff turnover must be reported for the most recent
3756	12-month period ending on the last workday of the most recent
3757	calendar quarter prior to the date the information is submitted.
3758	The turnover rate must be computed quarterly, with the annual
3759	rate being the cumulative sum of the quarterly rates. The
3760	turnover rate is the total number of terminations or separations
3761	experienced during the quarter, excluding any employee
3762	terminated during a probationary period of 3 months or less,
3763	divided by the total number of staff employed at the end of the
3764	period for which the rate is computed, and expressed as a
3765	percentage.
3766	3.(c)  The formula for determining staff stability is the
3767	total number of employees that have been employed for more than
3768	12 months, divided by the total number of employees employed at
3769	the end of the most recent calendar quarter, and expressed as a
3770	percentage.
3771	(b)(d)  A nursing facility that has failed to comply with
3772	state minimum-staffing requirements for 2 consecutive days is
3773	prohibited from accepting new admissions until the facility has
3774	achieved the minimum-staffing requirements for a period of 6
3775	consecutive days. For the purposes of this paragraph, any person
3776	who was a resident of the facility and was absent from the
3777	facility for the purpose of receiving medical care at a separate
3778	location or was on a leave of absence is not considered a new
3779	admission. Failure to impose such an admissions moratorium
3780	constitutes a class II deficiency.
3781	(c)(e)  A nursing facility that which does not have a
3782	conditional license may be cited for failure to comply with the
3783	standards in s. 400.23(3)(a) only if it has failed to meet those
3784	standards on 2 consecutive days or if it has failed to meet at
3785	least 97 percent of those standards on any one day.
3786	(d)(f)  A facility that which has a conditional license
3787	must be in compliance with the standards in s. 400.23(3)(a) at
3788	all times from the effective date of the conditional license
3789	until the effective date of a subsequent standard license.
3790
3791	Nothing in this subsection section shall limit the agency's
3792	ability to impose a deficiency or take other actions if a
3793	facility does not have enough staff to meet the residents'
3794	needs.
3795	(16)  Report by the 10th calendar day of each month monthly
3796	the number of vacant beds in the facility that which are
3797	available for resident occupancy on the last day of the prior
3798	month information is reported.
3799
3800	Facilities that have been awarded a Gold Seal under the program
3801	established in s. 400.235 may develop a plan to provide
3802	certified nursing assistant training as prescribed by federal
3803	regulations and state rules and may apply to the agency for
3804	approval of their program.
3805	Section 76.  Subsection (6) of section 400.162, Florida
3806	Statutes, is amended to read:
3807	400.162  Property and personal affairs of residents.--
3808	(6)  In the event of the death of a resident, a licensee
3809	shall return all refunds and funds held in trust to the
3810	resident's personal representative, if one has been appointed at
3811	the time the nursing home disburses such funds, and if not, to
3812	the resident's spouse or adult next of kin named in a
3813	beneficiary designation form provided by the nursing home to the
3814	resident. In the event the resident has not completed the
3815	beneficiary designation form or the resident's designated spouse
3816	or adult next of kin is deceased or cannot be located and no
3817	personal representative has been appointed, the nursing home may
3818	release funds to the funeral home that is handling the deceased
3819	resident's remains for the funeral home's actual charges for the
3820	services performed. In all other situations no spouse or adult
3821	next of kin or such person cannot be located, funds due to the
3822	resident shall be placed in an interest-bearing account in a
3823	bank, savings association, trust company, or credit union
3824	located in this state and, if possible, located within the same
3825	district in which the facility is located, which funds shall not
3826	be represented as part of the assets of the facility on a
3827	financial statement, and the licensee shall maintain such
3828	account until such time as the trust funds are disbursed
3829	pursuant to the provisions of the Florida Probate Code. All
3830	other property of a deceased resident being held in trust by the
3831	licensee shall be returned to the resident's personal
3832	representative, if one has been appointed at the time the
3833	nursing home disburses such property, and if not, to the
3834	resident's spouse or adult next of kin named in a beneficiary
3835	designation form provided by the nursing home to the resident.
3836	In the event the resident has no spouse or adult next of kin or
3837	such person cannot be located, property being held in trust
3838	shall be safeguarded until such time as the property is
3839	disbursed pursuant to the provisions of the Florida Probate
3840	Code. The trust funds and property of deceased residents shall
3841	be kept separate from the funds and the property of the licensee
3842	and from the funds and property of the residents of the
3843	facility. The nursing home needs to maintain only one account in
3844	which the trust funds amounting to less than $100 of deceased
3845	residents are placed. However, it shall be the obligation of the
3846	nursing home to maintain adequate records to permit compilation
3847	of interest due each individual resident's account. Separate
3848	accounts shall be maintained with respect to trust funds of
3849	deceased residents equal to or in excess of $100. In the event
3850	the trust funds of the deceased resident are not disbursed
3851	pursuant to the provisions of the Florida Probate Code within 2
3852	years of the death of the resident, the trust funds shall be
3853	deposited in the Resident Protection Trust Fund and expended as
3854	provided for in s. 400.063, notwithstanding the provisions of
3855	any other law of this state. Any other property of a deceased
3856	resident held in trust by a licensee which is not disbursed in
3857	accordance with the provisions of the Florida Probate Code shall
3858	escheat to the state as provided by law.
3859	Section 77.  Section 400.179, Florida Statutes, is amended
3860	to read:
3861	400.179  Sale or transfer of ownership of a nursing
3862	facility; Liability for Medicaid underpayments and
3863	overpayments.--
3864	(1)  It is the intent of the Legislature to protect the
3865	rights of nursing home residents and the security of public
3866	funds when a nursing facility is sold or the ownership is
3867	transferred.
3868	(2)  Whenever a nursing facility is sold or the ownership
3869	is transferred, including leasing, the transferee shall make
3870	application to the agency for a new license at least 90 days
3871	prior to the date of transfer of ownership.
3872	(3)  The transferor shall notify the agency in writing at
3873	least 90 days prior to the date of transfer of ownership. The
3874	transferor shall be responsible and liable for the lawful
3875	operation of the nursing facility and the welfare of the
3876	residents domiciled in the facility until the date the
3877	transferee is licensed by the agency. The transferor shall be
3878	liable for any and all penalties imposed against the facility
3879	for violations occurring prior to the date of transfer of
3880	ownership.
3881	(4)  The transferor shall, prior to transfer of ownership,
3882	repay or make arrangements to repay to the agency or the
3883	Department of Children and Family Services any amounts owed to
3884	the agency or the department. Should the transferor fail to
3885	repay or make arrangements to repay the amounts owed to the
3886	agency or the department prior to the transfer of ownership, the
3887	issuance of a license to the transferee shall be delayed until
3888	repayment or until arrangements for repayment are made.
3889	(2)(5)  Because any transfer of a nursing facility may
3890	expose the fact that Medicaid may have underpaid or overpaid the
3891	transferor, and because in most instances, any such underpayment
3892	or overpayment can only be determined following a formal field
3893	audit, the liabilities for any such underpayments or
3894	overpayments shall be as follows:
3895	(a)  The Medicaid program shall be liable to the transferor
3896	for any underpayments owed during the transferor's period of
3897	operation of the facility.
3898	(b)  Without regard to whether the transferor had leased or
3899	owned the nursing facility, the transferor shall remain liable
3900	to the Medicaid program for all Medicaid overpayments received
3901	during the transferor's period of operation of the facility,
3902	regardless of when determined.
3903	(c)  Where the facility transfer takes any form of a sale
3904	of assets, in addition to the transferor's continuing liability
3905	for any such overpayments, if the transferor fails to meet these
3906	obligations, the transferee shall be liable for all liabilities
3907	that can be readily identifiable 90 days in advance of the
3908	transfer. Such liability shall continue in succession until the
3909	debt is ultimately paid or otherwise resolved. It shall be the
3910	burden of the transferee to determine the amount of all such
3911	readily identifiable overpayments from the Agency for Health
3912	Care Administration, and the agency shall cooperate in every way
3913	with the identification of such amounts. Readily identifiable
3914	overpayments shall include overpayments that will result from,
3915	but not be limited to:
3916	1.  Medicaid rate changes or adjustments;
3917	2.  Any depreciation recapture;
3918	3.  Any recapture of fair rental value system indexing; or
3919	4.  Audits completed by the agency.
3920
3921	The transferor shall remain liable for any such Medicaid
3922	overpayments that were not readily identifiable 90 days in
3923	advance of the nursing facility transfer.
3924	(d)  Where the transfer involves a facility that has been
3925	leased by the transferor:
3926	1.  The transferee shall, as a condition to being issued a
3927	license by the agency, acquire, maintain, and provide proof to
3928	the agency of a bond with a term of 30 months, renewable
3929	annually, in an amount not less than the total of 3 months
3930	Medicaid payments to the facility computed on the basis of the
3931	preceding 12-month average Medicaid payments to the facility.
3932	2.  A leasehold licensee may meet the requirements of
3933	subparagraph 1. by payment of a nonrefundable fee, paid at
3934	initial licensure, paid at the time of any subsequent change of
3935	ownership, and paid annually thereafter at the time of any
3936	subsequent annual license renewal, in the amount of 2 percent of
3937	the total of 3 months' Medicaid payments to the facility
3938	computed on the basis of the preceding 12-month average Medicaid
3939	payments to the facility. If a preceding 12-month average is not
3940	available, projected Medicaid payments may be used. The fee
3941	shall be deposited into the Health Care Trust Fund and shall be
3942	accounted for separately as a Medicaid nursing home overpayment
3943	account. These fees shall be used at the sole discretion of the
3944	agency to repay nursing home Medicaid overpayments. Payment of
3945	this fee shall not release the licensee from any liability for
3946	any Medicaid overpayments, nor shall payment bar the agency from
3947	seeking to recoup overpayments from the licensee and any other
3948	liable party. As a condition of exercising this lease bond
3949	alternative, licensees paying this fee must maintain an existing
3950	lease bond through the end of the 30-month term period of that
3951	bond. The agency is herein granted specific authority to
3952	promulgate all rules pertaining to the administration and
3953	management of this account, including withdrawals from the
3954	account, subject to federal review and approval. This provision
3955	shall take effect upon becoming law and shall apply to any
3956	leasehold license application.
3957	a.  The financial viability of the Medicaid nursing home
3958	overpayment account shall be determined by the agency through
3959	annual review of the account balance and the amount of total
3960	outstanding, unpaid Medicaid overpayments owing from leasehold
3961	licensees to the agency as determined by final agency audits.
3962	b.  The agency, in consultation with the Florida Health
3963	Care Association and the Florida Association of Homes for the
3964	Aging, shall study and make recommendations on the minimum
3965	amount to be held in reserve to protect against Medicaid
3966	overpayments to leasehold licensees and on the issue of
3967	successor liability for Medicaid overpayments upon sale or
3968	transfer of ownership of a nursing facility. The agency shall
3969	submit the findings and recommendations of the study to the
3970	Governor, the President of the Senate, and the Speaker of the
3971	House of Representatives by January 1, 2003.
3972	3.  The leasehold licensee may meet the bond requirement
3973	through other arrangements acceptable to the agency. The agency
3974	is herein granted specific authority to promulgate rules
3975	pertaining to lease bond arrangements.
3976	4.  All existing nursing facility licensees, operating the
3977	facility as a leasehold, shall acquire, maintain, and provide
3978	proof to the agency of the 30-month bond required in
3979	subparagraph 1., above, on and after July 1, 1993, for each
3980	license renewal.
3981	5.  It shall be the responsibility of all nursing facility
3982	operators, operating the facility as a leasehold, to renew the
3983	30-month bond and to provide proof of such renewal to the agency
3984	annually at the time of application for license renewal.
3985	6.  Any failure of the nursing facility operator to
3986	acquire, maintain, renew annually, or provide proof to the
3987	agency shall be grounds for the agency to deny, cancel, revoke,
3988	and or suspend the facility license to operate such facility and
3989	to take any further action, including, but not limited to,
3990	enjoining the facility, asserting a moratorium pursuant to part
3991	II of chapter 408, or applying for a receiver, deemed necessary
3992	to ensure compliance with this section and to safeguard and
3993	protect the health, safety, and welfare of the facility's
3994	residents. A lease agreement required as a condition of bond
3995	financing or refinancing under s. 154.213 by a health facilities
3996	authority or required under s. 159.30 by a county or
3997	municipality is not a leasehold for purposes of this paragraph
3998	and is not subject to the bond requirement of this paragraph.
3999	Section 78.  Subsections (1) and (4) of section 400.18,
4000	Florida Statutes, are amended to read:
4001	400.18  Closing of nursing facility.--
4002	(1)  In addition to the requirements of part II of chapter
4003	408, Whenever a licensee voluntarily discontinues operation, and
4004	during the period when it is preparing for such discontinuance,
4005	it shall inform the agency not less than 90 days prior to the
4006	discontinuance of operation. the licensee also shall inform each
4007	the resident or the next of kin, legal representative, or agency
4008	acting on behalf of the resident of the fact, and the proposed
4009	time, of such discontinuance of operation and give at least 90
4010	days' notice so that suitable arrangements may be made for the
4011	transfer and care of the resident. In the event any resident has
4012	no such person to represent him or her, the licensee shall be
4013	responsible for securing a suitable transfer of the resident
4014	before the discontinuance of operation. The agency shall be
4015	responsible for arranging for the transfer of those residents
4016	requiring transfer who are receiving assistance under the
4017	Medicaid program.
4018	(4)  Immediately upon discontinuance of operation of a
4019	facility, the licensee shall surrender the license therefor to
4020	the agency, and the license shall be canceled.
4021	Section 79.  Subsections (1), (2), and (3) of section
4022	400.19, Florida Statutes, are amended to read:
4023	400.19  Right of entry and inspection.--
4024	(1)  In accordance with part II of chapter 408, the agency
4025	and any duly designated officer or employee thereof or a member
4026	of the State Long-Term Care Ombudsman Council or the local long-
4027	term care ombudsman council shall have the right to enter upon
4028	and into the premises of any facility licensed pursuant to this
4029	part, or any distinct nursing home unit of a hospital licensed
4030	under chapter 395 or any freestanding facility licensed under
4031	chapter 395 that provides extended care or other long-term care
4032	services, at any reasonable time in order to determine the state
4033	of compliance with the provisions of this part and rules in
4034	force pursuant thereto. The right of entry and inspection shall
4035	also extend to any premises which the agency has reason to
4036	believe is being operated or maintained as a facility without a
4037	license, but no such entry or inspection of any premises shall
4038	be made without the permission of the owner or person in charge
4039	thereof, unless a warrant is first obtained from the circuit
4040	court authorizing same. Any application for a facility license
4041	or renewal thereof, made pursuant to this part, shall constitute
4042	permission for and complete acquiescence in any entry or
4043	inspection of the premises for which the license is sought, in
4044	order to facilitate verification of the information submitted on
4045	or in connection with the application; to discover, investigate,
4046	and determine the existence of abuse or neglect; or to elicit,
4047	receive, respond to, and resolve complaints. The agency shall,
4048	within 60 days after receipt of a complaint made by a resident
4049	or resident's representative, complete its investigation and
4050	provide to the complainant its findings and resolution.
4051	(2)  The agency shall coordinate nursing home facility
4052	licensing activities and responsibilities of any duly designated
4053	officer or employee involved in nursing home facility inspection
4054	to assure necessary, equitable, and consistent supervision of
4055	inspection personnel without unnecessary duplication of
4056	inspections, consultation services, or complaint investigations.
4057	To facilitate such coordination, all rules promulgated by the
4058	agency pursuant to this part shall be distributed to nursing
4059	homes licensed under s. 400.062 30 days prior to implementation.
4060	This requirement does not apply to emergency rules.
4061	(3)  The agency shall every 15 months conduct at least one
4062	unannounced inspection to determine compliance by the licensee
4063	with statutes, and with rules promulgated under the provisions
4064	of those statutes, governing minimum standards of construction,
4065	quality and adequacy of care, and rights of residents. The
4066	survey shall be conducted every 6 months for the next 2-year
4067	period if the facility has been cited for a class I deficiency,
4068	has been cited for two or more class II deficiencies arising
4069	from separate surveys or investigations within a 60-day period,
4070	or has had three or more substantiated complaints within a 6-
4071	month period, each resulting in at least one class I or class II
4072	deficiency. In addition to any other fees or fines in this part,
4073	the agency shall assess a fine for each facility that is subject
4074	to the 6-month survey cycle. The fine for the 2-year period
4075	shall be $6,000, one-half to be paid at the completion of each
4076	survey. The agency may adjust this fine by the change in the
4077	Consumer Price Index, based on the 12 months immediately
4078	preceding the increase, to cover the cost of the additional
4079	surveys. The agency shall verify through subsequent inspection
4080	that any deficiency identified during the annual inspection is
4081	corrected. However, the agency may verify the correction of a
4082	class III or class IV deficiency unrelated to resident rights or
4083	resident care without reinspecting the facility if adequate
4084	written documentation has been received from the facility, which
4085	provides assurance that the deficiency has been corrected. The
4086	giving or causing to be given of advance notice of such
4087	unannounced inspections by an employee of the agency to any
4088	unauthorized person shall constitute cause for suspension of not
4089	fewer than 5 working days according to the provisions of chapter
4090	110.
4091	Section 80.  Section 400.191, Florida Statutes, is amended
4092	to read:
4093	400.191  Availability, distribution, and posting of reports
4094	and records.--
4095	(1)  The agency shall provide information to the public
4096	about all of the licensed nursing home facilities operating in
4097	the state. The agency shall, within 60 days after an annual
4098	inspection visit or within 30 days after any interim visit to a
4099	facility, send copies of the inspection reports to the local
4100	long-term care ombudsman council, the agency's local office, and
4101	a public library or the county seat for the county in which the
4102	facility is located. The agency may provide electronic access to
4103	inspection reports as a substitute for sending copies.
4104	(2)  The agency shall publish the Nursing Home Guide
4105	provide additional information in consumer-friendly printed and
4106	electronic formats to assist consumers and their families in
4107	comparing and evaluating nursing home facilities.
4108	(a)  The agency shall provide an Internet site which shall
4109	include at least the following information either directly or
4110	indirectly through a link to another established site or sites
4111	of the agency's choosing:
4112	1.  A list by name and address of all nursing home
4113	facilities in this state, including any prior name a facility
4114	was known by during the previous 12-month period.
4115	2.  Whether such nursing home facilities are proprietary or
4116	nonproprietary.
4117	3.  The current owner of the facility's license and the
4118	year that that entity became the owner of the license.
4119	4.  The name of the owner or owners of each facility and
4120	whether the facility is affiliated with a company or other
4121	organization owning or managing more than one nursing facility
4122	in this state.
4123	5.  The total number of beds in each facility and the most
4124	recently available occupancy levels.
4125	6.  The number of private and semiprivate rooms in each
4126	facility.
4127	7.  The religious affiliation, if any, of each facility.
4128	8.  The languages spoken by the administrator and staff of
4129	each facility.
4130	9.  Whether or not each facility accepts Medicare or
4131	Medicaid recipients or insurance, health maintenance
4132	organization, Veterans Administration, CHAMPUS program, or
4133	workers' compensation coverage.
4134	10.  Recreational and other programs available at each
4135	facility.
4136	11.  Special care units or programs offered at each
4137	facility.
4138	12.  Whether the facility is a part of a retirement
4139	community that offers other services pursuant to part III, part
4140	IV, or part V.
4141	13.  Survey and deficiency information contained on the
4142	Online Survey Certification and Reporting (OSCAR) system of the
4143	federal Health Care Financing Administration, including all
4144	federal and state recertification, licensure annual survey,
4145	revisit, and complaint survey information, for each facility for
4146	the past 30 45 months. For noncertified nursing homes, state
4147	survey and deficiency information, including licensure annual
4148	survey, revisit, and complaint survey information for the past
4149	30 45 months shall be provided.
4150	14.  A summary of the deficiency Online Survey
4151	Certification and Reporting (OSCAR) data for each facility over
4152	the past 30 45 months. Such summary may include a score, rating,
4153	or comparison ranking with respect to other facilities based on
4154	the number of citations received by the facility on
4155	recertification, licensure of annual, revisit, and complaint
4156	surveys; the severity and scope of the citations; and the number
4157	of annual recertification surveys the facility has had during
4158	the past 30 45 months. The score, rating, or comparison ranking
4159	may be presented in either numeric or symbolic form for the
4160	intended consumer audience.
4161	(b)  The agency shall provide the following information in
4162	printed form:
4163	1.  A list by name and address of all nursing home
4164	facilities in this state.
4165	2.  Whether such nursing home facilities are proprietary or
4166	nonproprietary.
4167	3.  The current owner or owners of the facility's license
4168	and the year that entity became the owner of the license.
4169	4.  The total number of beds, and of private and
4170	semiprivate rooms, in each facility.
4171	5.  The religious affiliation, if any, of each facility.
4172	6.  The name of the owner of each facility and whether the
4173	facility is affiliated with a company or other organization
4174	owning or managing more than one nursing facility in this state.
4175	7.  The languages spoken by the administrator and staff of
4176	each facility.
4177	8.  Whether or not each facility accepts Medicare or
4178	Medicaid recipients or insurance, health maintenance
4179	organization, Veterans Administration, CHAMPUS program, or
4180	workers' compensation coverage.
4181	9.  Recreational programs, special care units, and other
4182	programs available at each facility.
4183	10.  The Internet address for the site where more detailed
4184	information can be seen.
4185	11.  A statement advising consumers that each facility will
4186	have its own policies and procedures related to protecting
4187	resident property.
4188	12.  A summary of the deficiency Online Survey
4189	Certification and Reporting (OSCAR) data for each facility over
4190	the past 45 months. Such summary may include a score, rating, or
4191	comparison ranking with respect to other facilities based on the
4192	number of citations received by the facility on recertification,
4193	licensure annual, revisit, and complaint surveys; the severity
4194	and scope of the citations; the number of citations; and the
4195	number of annual recertification surveys the facility has had
4196	during the past 30 45 months. The score, rating, or comparison
4197	ranking may be presented in either numeric or symbolic form for
4198	the intended consumer audience.
4199	(c)  For purposes of this subsection, references to the
4200	Online Survey Certification and Reporting (OSCAR) system shall
4201	refer to any future system that the Health Care Financing
4202	Administration develops to replace the current OSCAR system.
4203	(c)(d)  The agency may provide the following additional
4204	information on an Internet site or in printed form as the
4205	information becomes available:
4206	1.  The licensure status history of each facility.
4207	2.  The rating history of each facility.
4208	3.  The regulatory history of each facility, which may
4209	include federal sanctions, state sanctions, federal fines, state
4210	fines, and other actions.
4211	4.  Whether the facility currently possesses the Gold Seal
4212	designation awarded pursuant to s. 400.235.
4213	5.  Internet links to the Internet sites of the facilities
4214	or their affiliates.
4215	(3)  Each nursing home facility licensee shall maintain as
4216	public information, available upon request, records of all cost
4217	and inspection reports pertaining to that facility that have
4218	been filed with, or issued by, any governmental agency. Copies
4219	of such reports shall be retained in such records for not less
4220	than 5 years from the date the reports are filed or issued.
4221	(a)  The agency shall quarterly publish in the Nursing Home
4222	Guide a "Nursing Home Guide Watch List" to assist consumers in
4223	evaluating the quality of nursing home care in Florida. The
4224	watch list must identify each facility that met the criteria for
4225	a conditional licensure status to be noticed as specified in
4226	this section on any day within the quarter covered by the list
4227	and each facility that is was operating under bankruptcy
4228	protection on any day within the quarter. The watch list must
4229	include, but is not limited to, the facility's name, address,
4230	and ownership; the county in which the facility operates; the
4231	license expiration date; the number of licensed beds; a
4232	description of the deficiency causing the facility to be placed
4233	on the list; any corrective action taken; and the cumulative
4234	number of days and percentage of days times the facility had a
4235	conditional license in the past 30 months has been on a watch
4236	list. The watch list must include a brief description regarding
4237	how to choose a nursing home, the categories of licensure, the
4238	agency's inspection process, an explanation of terms used in the
4239	watch list, and the addresses and phone numbers of the agency's
4240	managed care and health quality assurance field area offices.
4241	(b)  Upon publication of each quarterly Nursing Home Guide
4242	watch list, the agency must post transmit a copy on its website
4243	by the 15th calendar day 2 months following the end of the
4244	calendar quarter. Each nursing home licensee must retrieve the
4245	most recent version of the Nursing Home Guide from of the watch
4246	list to each nursing home facility by mail and must make the
4247	watch list available on the agency's Internet website.
4248	(4)  Any records of a nursing home facility determined by
4249	the agency to be necessary and essential to establish lawful
4250	compliance with any rules or standards shall be made available
4251	to the agency on the premises of the facility and submitted to
4252	the agency. Each facility must submit this information
4253	electronically when electronic transmission to the agency is
4254	available.
4255	(5)  Every nursing home facility licensee shall:
4256	(a)  Post, in a sufficient number of prominent positions in
4257	the nursing home so as to be accessible to all residents and to
4258	the general public:
4259	1.  A concise summary of the last inspection report
4260	pertaining to the nursing home and issued by the agency, with
4261	references to the page numbers of the full reports, noting any
4262	deficiencies found by the agency and the actions taken by the
4263	licensee to rectify such deficiencies and indicating in such
4264	summaries where the full reports may be inspected in the nursing
4265	home.
4266	2.  A copy of all pages listing the facility from the most
4267	recent version of the Florida Nursing Home Guide Watch List.
4268	(b)  Upon request, provide to any person who has completed
4269	a written application with an intent to be admitted to, or to
4270	any resident of, such nursing home, or to any relative, spouse,
4271	or guardian of such person, a copy of the last inspection report
4272	pertaining to the nursing home and issued by the agency,
4273	provided the person requesting the report agrees to pay a
4274	reasonable charge to cover copying costs.
4275	(6)  The agency may adopt rules as necessary to administer
4276	this section.
4277	Section 81.  Section 400.20, Florida Statutes, is amended
4278	to read:
4279	400.20  Licensed nursing home administrator required.--A No
4280	nursing home may not shall operate except under the supervision
4281	of a licensed nursing home administrator, and a no person may
4282	not shall be a nursing home administrator unless he or she holds
4283	is the holder of a current license as provided in chapter 468.
4284	Section 82.  Subsections (2), (7), and (8) of section
4285	400.23, Florida Statutes, are amended to read:
4286	400.23  Rules; evaluation and deficiencies; licensure
4287	status.--
4288	(2)  Pursuant to the intention of the Legislature, the
4289	agency, in consultation with the Department of Health and the
4290	Department of Elderly Affairs, shall adopt and enforce rules to
4291	implement this part and part II of chapter 408, which shall
4292	include reasonable and fair criteria in relation to:
4293	(a)  The location of the facility and housing conditions
4294	that will ensure the health, safety, and comfort of residents,
4295	including an adequate call system. In making such rules, the
4296	agency shall be guided by criteria recommended by nationally
4297	recognized reputable professional groups and associations with
4298	knowledge of such subject matters. The agency shall update or
4299	revise such criteria as the need arises. The agency may require
4300	alterations to a building if it determines that an existing
4301	condition constitutes a distinct hazard to life, health, or
4302	safety. In performing any inspections of facilities authorized
4303	by this part, the agency may enforce the special-occupancy
4304	provisions of the Florida Building Code and the Florida Fire
4305	Prevention Code which apply to nursing homes. The agency is
4306	directed to provide assistance to the Florida Building
4307	Commission in updating the construction standards of the code
4308	relative to nursing homes. A resident or the representative of
4309	the resident shall be able to request a change in the placement
4310	of the bed in his or her room, provided that at admission the
4311	resident or the representative of the resident is presented with
4312	a room that meets requirements of the Florida Building Code. The
4313	location of a bed may be changed if the requested placement does
4314	not infringe on the resident's roommate or interfere with the
4315	resident's care or safety as determined by the care planning
4316	team in accordance with facility policies and procedures. In
4317	addition, the bed placement may not be used as a restraint. Each
4318	facility shall maintain a log of resident rooms with beds that
4319	are not in strict compliance with the Florida Building Code in
4320	order for such log to be used by surveyors and nurse monitors
4321	during inspections and visits. Any resident or representative of
4322	a resident who requests that a bed be moved shall sign a
4323	statement indicating that he or she understands the room will
4324	not be in compliance with the Florida Building Code, but he or
4325	she would prefer to exercise his or her right to self-
4326	determination. The statement must be retained as part of the
4327	resident's care plan. Any facility that offers this option shall
4328	submit to the agency a letter signed by the nursing home
4329	administrator of record notifying the agency of this practice
4330	and include a copy of the facility's policies and procedures.
4331	(b)  The number and qualifications of all personnel,
4332	including management, medical, nursing, and other professional
4333	personnel, and nursing assistants, orderlies, and support
4334	personnel, having responsibility for any part of the care given
4335	residents.
4336	(c)  All sanitary conditions within the facility and its
4337	surroundings, including water supply, sewage disposal, food
4338	handling, and general hygiene which will ensure the health and
4339	comfort of residents.
4340	(d)  The equipment essential to the health and welfare of
4341	the residents.
4342	(e)  A uniform accounting system.
4343	(f)  The care, treatment, and maintenance of residents and
4344	measurement of the quality and adequacy thereof, based on rules
4345	developed under this chapter and the Omnibus Budget
4346	Reconciliation Act of 1987 (Pub. L. No. 100-203) (December 22,
4347	1987), Title IV (Medicare, Medicaid, and Other Health-Related
4348	Programs), Subtitle C (Nursing Home Reform), as amended.
4349	(g)  The preparation and annual update of a comprehensive
4350	emergency management plan. The agency shall adopt rules
4351	establishing minimum criteria for the plan after consultation
4352	with the Department of Community Affairs. At a minimum, the
4353	rules must provide for plan components that address emergency
4354	evacuation transportation; adequate sheltering arrangements;
4355	postdisaster activities, including emergency power, food, and
4356	water; postdisaster transportation; supplies; staffing;
4357	emergency equipment; individual identification of residents and
4358	transfer of records; and responding to family inquiries. The
4359	comprehensive emergency management plan is subject to review and
4360	approval by the local emergency management agency. During its
4361	review, the local emergency management agency shall ensure that
4362	the following agencies, at a minimum, are given the opportunity
4363	to review the plan: the Department of Elderly Affairs, the
4364	Department of Health, the Agency for Health Care Administration,
4365	and the Department of Community Affairs. Also, appropriate
4366	volunteer organizations must be given the opportunity to review
4367	the plan. The local emergency management agency shall complete
4368	its review within 60 days and either approve the plan or advise
4369	the facility of necessary revisions.
4370	(h)  The availability, distribution, and posting of reports
4371	and records pursuant to s. 400.191 and the Gold Seal Program
4372	pursuant to s. 400.235.
4373	(7)  The agency shall, at least every 15 months, evaluate
4374	all nursing home facilities and make a determination as to the
4375	degree of compliance by each licensee with the established rules
4376	adopted under this part as a basis for assigning a licensure
4377	status to that facility. The agency shall base its evaluation on
4378	the most recent inspection report, taking into consideration
4379	findings from other official reports, surveys, interviews,
4380	investigations, and inspections. The agency shall assign a
4381	licensure status of standard or conditional to each nursing
4382	home.
4383	(a)  A standard licensure status means that a facility has
4384	no class I or class II deficiencies and has corrected all class
4385	III deficiencies within the time established by the agency.
4386	(b)  A conditional licensure status means that a facility,
4387	due to the presence of one or more class I or class II
4388	deficiencies, or class III deficiencies not corrected within the
4389	time established by the agency, is not in substantial compliance
4390	at the time of the survey with criteria established under this
4391	part or with rules adopted by the agency. If the facility has no
4392	class I, class II, or class III deficiencies at the time of the
4393	followup survey, a standard licensure status may be assigned.
4394	(c)  In evaluating the overall quality of care and services
4395	and determining whether the facility will receive a conditional
4396	or standard license, the agency shall consider the needs and
4397	limitations of residents in the facility and the results of
4398	interviews and surveys of a representative sampling of
4399	residents, families of residents, ombudsman council members in
4400	the planning and service area in which the facility is located,
4401	guardians of residents, and staff of the nursing home facility.
4402	(d)  The current licensure status of each facility must be
4403	indicated in bold print on the face of the license. A list of
4404	the deficiencies of the facility shall be posted in a prominent
4405	place that is in clear and unobstructed public view at or near
4406	the place where residents are being admitted to that facility.
4407	Licensees receiving a conditional licensure status for a
4408	facility shall prepare, within 10 working days after receiving
4409	notice of deficiencies, a plan for correction of all
4410	deficiencies and shall submit the plan to the agency for
4411	approval.
4412	(e)  Each licensee shall post its license in a prominent
4413	place that is in clear and unobstructed public view at or near
4414	the place where residents are being admitted to the facility.
4415	(e)(f)  The agency shall adopt rules that:
4416	1.  Establish uniform procedures for the evaluation of
4417	facilities.
4418	2.  Provide criteria in the areas referenced in paragraph
4419	(c).
4420	3.  Address other areas necessary for carrying out the
4421	intent of this section.
4422	(8)  The agency shall adopt rules pursuant to this part and
4423	part II of chapter 408 to provide that, when the criteria
4424	established under subsection (2) are not met, such deficiencies
4425	shall be classified according to the nature and the scope of the
4426	deficiency. The scope shall be cited as isolated, patterned, or
4427	widespread. An isolated deficiency is a deficiency affecting one
4428	or a very limited number of residents, or involving one or a
4429	very limited number of staff, or a situation that occurred only
4430	occasionally or in a very limited number of locations. A
4431	patterned deficiency is a deficiency where more than a very
4432	limited number of residents are affected, or more than a very
4433	limited number of staff are involved, or the situation has
4434	occurred in several locations, or the same resident or residents
4435	have been affected by repeated occurrences of the same deficient
4436	practice but the effect of the deficient practice is not found
4437	to be pervasive throughout the facility. A widespread deficiency
4438	is a deficiency in which the problems causing the deficiency are
4439	pervasive in the facility or represent systemic failure that has
4440	affected or has the potential to affect a large portion of the
4441	facility's residents. The agency shall indicate the
4442	classification on the face of the notice of deficiencies as
4443	follows:
4444	(a)  A class I deficiency is a deficiency that the agency
4445	determines presents a situation in which immediate corrective
4446	action is necessary because the facility's noncompliance has
4447	caused, or is likely to cause, serious injury, harm, impairment,
4448	or death to a resident receiving care in a facility. The
4449	condition or practice constituting a class I violation shall be
4450	abated or eliminated immediately, unless a fixed period of time,
4451	as determined by the agency, is required for correction. A class
4452	I deficiency is subject to a civil penalty of $10,000 for an
4453	isolated deficiency, $12,500 for a patterned deficiency, and
4454	$15,000 for a widespread deficiency. The fine amount shall be
4455	doubled for each deficiency if the facility was previously cited
4456	for one or more class I or class II deficiencies during the last
4457	annual inspection or any inspection or complaint investigation
4458	since the last annual inspection. A fine must be levied
4459	notwithstanding the correction of the deficiency.
4460	(b)  A class II deficiency is a deficiency that the agency
4461	determines has compromised the resident's ability to maintain or
4462	reach his or her highest practicable physical, mental, and
4463	psychosocial well-being, as defined by an accurate and
4464	comprehensive resident assessment, plan of care, and provision
4465	of services. A class II deficiency is subject to a civil penalty
4466	of $2,500 for an isolated deficiency, $5,000 for a patterned
4467	deficiency, and $7,500 for a widespread deficiency. The fine
4468	amount shall be doubled for each deficiency if the facility was
4469	previously cited for one or more class I or class II
4470	deficiencies during the last licensure annual inspection or any
4471	inspection or complaint investigation since the last licensure
4472	annual inspection. A fine shall be levied notwithstanding the
4473	correction of the deficiency.
4474	(c)  A class III deficiency is a deficiency that the agency
4475	determines will result in no more than minimal physical, mental,
4476	or psychosocial discomfort to the resident or has the potential
4477	to compromise the resident's ability to maintain or reach his or
4478	her highest practical physical, mental, or psychosocial well-
4479	being, as defined by an accurate and comprehensive resident
4480	assessment, plan of care, and provision of services. A class III
4481	deficiency is subject to a civil penalty of $1,000 for an
4482	isolated deficiency, $2,000 for a patterned deficiency, and
4483	$3,000 for a widespread deficiency. The fine amount shall be
4484	doubled for each deficiency if the facility was previously cited
4485	for one or more class I or class II deficiencies during the last
4486	licensure annual inspection or any inspection or complaint
4487	investigation since the last annual inspection. A citation for a
4488	class III deficiency must specify the time within which the
4489	deficiency is required to be corrected. If a class III
4490	deficiency is corrected within the time specified, no civil
4491	penalty shall be imposed.
4492	(d)  A class IV deficiency is a deficiency that the agency
4493	determines has the potential for causing no more than a minor
4494	negative impact on the resident. If the class IV deficiency is
4495	isolated, no plan of correction is required.
4496	Section 83.  Subsections (3) and (4) of section 400.241,
4497	Florida Statutes, are renumbered as subsections (1) and (2),
4498	respectively, and present subsections (1) and (2) of said
4499	section are amended to read:
4500	400.241  Prohibited acts; penalties for violations.--
4501	(1)  It is unlawful for any person or public body to
4502	establish, conduct, manage, or operate a home as defined in this
4503	part without obtaining a valid current license.
4504	(2)  It is unlawful for any person or public body to offer
4505	or advertise to the public, in any way by any medium whatever,
4506	nursing home care or service or custodial services without
4507	obtaining a valid current license. It is unlawful for any holder
4508	of a license issued pursuant to the provisions of this part to
4509	advertise or hold out to the public that it holds a license for
4510	a facility other than that for which it actually holds a
4511	license.
4512	Section 84.  Subsections (6) through (27) of section
4513	400.402, Florida Statutes, are renumbered as subsections (5)
4514	through (26), respectively, and present subsections (5), (12),
4515	(14), (17), and (20) are amended to read:
4516	400.402  Definitions.--When used in this part, the term:
4517	(5)  "Applicant" means an individual owner, corporation,
4518	partnership, firm, association, or governmental entity that
4519	applies for a license.
4520	(11)(12)  "Extended congregate care" means acts beyond
4521	those authorized in subsection (16) (17) that may be performed
4522	pursuant to part I of chapter 464 by persons licensed thereunder
4523	while carrying out their professional duties, and other
4524	supportive services which may be specified by rule. The purpose
4525	of such services is to enable residents to age in place in a
4526	residential environment despite mental or physical limitations
4527	that might otherwise disqualify them from residency in a
4528	facility licensed under this part.
4529	(13)(14)  "Limited nursing services" means acts that may be
4530	performed pursuant to part I of chapter 464 by persons licensed
4531	thereunder while carrying out their professional duties but
4532	limited to those acts which the agency department specifies by
4533	rule. Acts which may be specified by rule as allowable limited
4534	nursing services shall be for persons who meet the admission
4535	criteria established by the agency department for assisted
4536	living facilities and shall not be complex enough to require 24-
4537	hour nursing supervision and may include such services as the
4538	application and care of routine dressings, and care of casts,
4539	braces, and splints.
4540	(16)(17)  "Personal services" means direct physical
4541	assistance with or supervision of the activities of daily living
4542	and the self-administration of medication and other similar
4543	services which the agency department may define by rule.
4544	"Personal services" shall not be construed to mean the provision
4545	of medical, nursing, dental, or mental health services.
4546	(19)(20)  "Resident" means a person 18 years of age or
4547	older, residing in and receiving care from a facility, including
4548	a person receiving services pursuant to s. 400.553(2).
4549	Section 85.  Section 400.407, Florida Statutes, is amended
4550	to read:
4551	400.407  License required; fee, display.--
4552	(1)  The requirements of part II of chapter 408 shall apply
4553	to the provision of services that require licensure pursuant
4554	this part and part II of chapter 408 and to entities licensed by
4555	or applying for such licensure from the agency pursuant to this
4556	part. However, each applicant for licensure and each licensee is
4557	exempt from s. 408.810(10). A license issued by the agency is
4558	required for an assisted living facility operating in this
4559	state.
4560	(2)  Separate licenses shall be required for facilities
4561	maintained in separate premises, even though operated under the
4562	same management. A separate license shall not be required for
4563	separate buildings on the same grounds.
4564	(3)  In addition to the requirements of 408.806, each Any
4565	license granted by the agency must state the maximum resident
4566	capacity of the facility, the type of care for which the license
4567	is granted, the date the license is issued, the expiration date
4568	of the license, and any other information deemed necessary by
4569	the agency. Licenses shall be issued for one or more of the
4570	following categories of care: standard, extended congregate
4571	care, limited nursing services, or limited mental health.
4572	(a)  A standard license shall be issued to facilities
4573	providing one or more of the personal services identified in s.
4574	400.402. Such facilities may also employ or contract with a
4575	person licensed under part I of chapter 464 to administer
4576	medications and perform other tasks as specified in s. 400.4255.
4577	(b)  An extended congregate care license shall be issued to
4578	facilities providing, directly or through contract, services
4579	beyond those authorized in paragraph (a), including acts
4580	performed pursuant to part I of chapter 464 by persons licensed
4581	thereunder, and supportive services defined by rule to persons
4582	who otherwise would be disqualified from continued residence in
4583	a facility licensed under this part.
4584	1.  In order for extended congregate care services to be
4585	provided in a facility licensed under this part, the agency must
4586	first determine that all requirements established in law and
4587	rule are met and must specifically designate, on the facility's
4588	license, that such services may be provided and whether the
4589	designation applies to all or part of a facility. Such
4590	designation may be made at the time of initial licensure or
4591	relicensure, or upon request in writing by a licensee under this
4592	part and part II of chapter 408. Notification of approval or
4593	denial of such request shall be made in accordance with part II
4594	of chapter 408 within 90 days after receipt of such request and
4595	all necessary documentation. Existing facilities qualifying to
4596	provide extended congregate care services must have maintained a
4597	standard license and may not have been subject to administrative
4598	sanctions during the previous 2 years, or since initial
4599	licensure if the facility has been licensed for less than 2
4600	years, for any of the following reasons:
4601	a.  A class I or class II violation;
4602	b.  Three or more repeat or recurring class III violations
4603	of identical or similar resident care standards as specified in
4604	rule from which a pattern of noncompliance is found by the
4605	agency;
4606	c.  Three or more class III violations that were not
4607	corrected in accordance with the corrective action plan approved
4608	by the agency;
4609	d.  Violation of resident care standards resulting in a
4610	requirement to employ the services of a consultant pharmacist or
4611	consultant dietitian;
4612	e.  Denial, suspension, or revocation of a license for
4613	another facility under this part in which the applicant for an
4614	extended congregate care license has at least 25 percent
4615	ownership interest; or
4616	f.  Imposition of a moratorium on admissions or initiation
4617	of injunctive proceedings.
4618	2.  Facilities that are licensed to provide extended
4619	congregate care services shall maintain a written progress
4620	report on each person who receives such services, which report
4621	describes the type, amount, duration, scope, and outcome of
4622	services that are rendered and the general status of the
4623	resident's health. A registered nurse, or appropriate designee,
4624	representing the agency shall visit such facilities at least
4625	quarterly to monitor residents who are receiving extended
4626	congregate care services and to determine if the facility is in
4627	compliance with this part, part II of chapter 408, and with
4628	rules that relate to extended congregate care. One of these
4629	visits may be in conjunction with the regular survey. The
4630	monitoring visits may be provided through contractual
4631	arrangements with appropriate community agencies. A registered
4632	nurse shall serve as part of the team that inspects such
4633	facility. The agency may waive one of the required yearly
4634	monitoring visits for a facility that has been licensed for at
4635	least 24 months to provide extended congregate care services,
4636	if, during the inspection, the registered nurse determines that
4637	extended congregate care services are being provided
4638	appropriately, and if the facility has no class I or class II
4639	violations and no uncorrected class III violations. Before such
4640	decision is made, the agency shall consult with the long-term
4641	care ombudsman council for the area in which the facility is
4642	located to determine if any complaints have been made and
4643	substantiated about the quality of services or care. The agency
4644	may not waive one of the required yearly monitoring visits if
4645	complaints have been made and substantiated.
4646	3.  Facilities that are licensed to provide extended
4647	congregate care services shall:
4648	a.  Demonstrate the capability to meet unanticipated
4649	resident service needs.
4650	b.  Offer a physical environment that promotes a homelike
4651	setting, provides for resident privacy, promotes resident
4652	independence, and allows sufficient congregate space as defined
4653	by rule.
4654	c.  Have sufficient staff available, taking into account
4655	the physical plant and firesafety features of the building, to
4656	assist with the evacuation of residents in an emergency, as
4657	necessary.
4658	d.  Adopt and follow policies and procedures that maximize
4659	resident independence, dignity, choice, and decisionmaking to
4660	permit residents to age in place to the extent possible, so that
4661	moves due to changes in functional status are minimized or
4662	avoided.
4663	e.  Allow residents or, if applicable, a resident's
4664	representative, designee, surrogate, guardian, or attorney in
4665	fact to make a variety of personal choices, participate in
4666	developing service plans, and share responsibility in
4667	decisionmaking.
4668	f.  Implement the concept of managed risk.
4669	g.  Provide, either directly or through contract, the
4670	services of a person licensed pursuant to part I of chapter 464.
4671	h.  In addition to the training mandated in s. 400.452,
4672	provide specialized training as defined by rule for facility
4673	staff.
4674	4.  Facilities licensed to provide extended congregate care
4675	services are exempt from the criteria for continued residency as
4676	set forth in rules adopted under s. 400.441. Facilities so
4677	licensed shall adopt their own requirements within guidelines
4678	for continued residency set forth by the department in rule.
4679	However, such facilities may not serve residents who require 24-
4680	hour nursing supervision. Facilities licensed to provide
4681	extended congregate care services shall provide each resident
4682	with a written copy of facility policies governing admission and
4683	retention.
4684	5.  The primary purpose of extended congregate care
4685	services is to allow residents, as they become more impaired,
4686	the option of remaining in a familiar setting from which they
4687	would otherwise be disqualified for continued residency. A
4688	facility licensed to provide extended congregate care services
4689	may also admit an individual who exceeds the admission criteria
4690	for a facility with a standard license, if the individual is
4691	determined appropriate for admission to the extended congregate
4692	care facility.
4693	6.  Before admission of an individual to a facility
4694	licensed to provide extended congregate care services, the
4695	individual must undergo a medical examination as provided in s.
4696	400.426(4) and the facility must develop a preliminary service
4697	plan for the individual.
4698	7.  When a facility can no longer provide or arrange for
4699	services in accordance with the resident's service plan and
4700	needs and the facility's policy, the facility shall make
4701	arrangements for relocating the person in accordance with s.
4702	400.428(1)(k).
4703	8.  Failure to provide extended congregate care services
4704	may result in denial of extended congregate care license
4705	renewal.
4706	9.  No later than January 1 of each year, the department,
4707	in consultation with the agency, shall prepare and submit to the
4708	Governor, the President of the Senate, the Speaker of the House
4709	of Representatives, and the chairs of appropriate legislative
4710	committees, a report on the status of, and recommendations
4711	related to, extended congregate care services. The status report
4712	must include, but need not be limited to, the following
4713	information:
4714	a.  A description of the facilities licensed to provide
4715	such services, including total number of beds licensed under
4716	this part.
4717	b.  The number and characteristics of residents receiving
4718	such services.
4719	c.  The types of services rendered that could not be
4720	provided through a standard license.
4721	d.  An analysis of deficiencies cited during licensure
4722	inspections.
4723	e.  The number of residents who required extended
4724	congregate care services at admission and the source of
4725	admission.
4726	f.  Recommendations for statutory or regulatory changes.
4727	g.  The availability of extended congregate care to state
4728	clients residing in facilities licensed under this part and in
4729	need of additional services, and recommendations for
4730	appropriations to subsidize extended congregate care services
4731	for such persons.
4732	h.  Such other information as the department considers
4733	appropriate.
4734	(c)  A limited nursing services license shall be issued to
4735	a facility that provides services beyond those authorized in
4736	paragraph (a) and as specified in this paragraph.
4737	1.  In order for limited nursing services to be provided in
4738	a facility licensed under this part, the agency must first
4739	determine that all requirements established in law and rule are
4740	met and must specifically designate, on the facility's license,
4741	that such services may be provided. Such designation may be made
4742	at the time of initial licensure or relicensure, or upon request
4743	in writing by a licensee under this part and part II of chapter
4744	408. Notification of approval or denial of such request shall be
4745	made in accordance with part II of chapter 408 within 90 days
4746	after receipt of such request and all necessary documentation.
4747	Existing facilities qualifying to provide limited nursing
4748	services shall have maintained a standard license and may not
4749	have been subject to administrative sanctions that affect the
4750	health, safety, and welfare of residents for the previous 2
4751	years or since initial licensure if the facility has been
4752	licensed for less than 2 years.
4753	2.  Facilities that are licensed to provide limited nursing
4754	services shall maintain a written progress report on each person
4755	who receives such nursing services, which report describes the
4756	type, amount, duration, scope, and outcome of services that are
4757	rendered and the general status of the resident's health. A
4758	registered nurse representing the agency shall visit such
4759	facilities at least twice a year to monitor residents who are
4760	receiving limited nursing services and to determine if the
4761	facility is in compliance with applicable provisions of this
4762	part, part II of chapter 408, and with related rules. The
4763	monitoring visits may be provided through contractual
4764	arrangements with appropriate community agencies. A registered
4765	nurse shall also serve as part of the team that inspects such
4766	facility.
4767	3.  A person who receives limited nursing services under
4768	this part must meet the admission criteria established by the
4769	agency for assisted living facilities. When a resident no longer
4770	meets the admission criteria for a facility licensed under this
4771	part, arrangements for relocating the person shall be made in
4772	accordance with s. 400.428(1)(k), unless the facility is
4773	licensed to provide extended congregate care services.
4774	(4)  In accordance with s. 408.805, an applicant or
4775	licensee shall pay a fee for each license application submitted
4776	under this part, part II of chapter 408, and applicable rules.
4777	The amount of the fee shall be established by rule.
4778	(a)  The biennial license fee required of a facility is
4779	$300 per license, with an additional fee of $50 per resident
4780	based on the total licensed resident capacity of the facility,
4781	except that no additional fee will be assessed for beds
4782	designated for recipients of optional state supplementation
4783	payments provided for in s. 409.212. The total fee may not
4784	exceed $10,000, no part of which shall be returned to the
4785	facility. The agency shall adjust the per bed license fee and
4786	the total licensure fee annually by not more than the change in
4787	the consumer price index based on the 12 months immediately
4788	preceding the increase.
4789	(b)  In addition to the total fee assessed under paragraph
4790	(a), the agency shall require facilities that are licensed to
4791	provide extended congregate care services under this part to pay
4792	an additional fee per licensed facility. The amount of the
4793	biennial fee shall be $400 per license, with an additional fee
4794	of $10 per resident based on the total licensed resident
4795	capacity of the facility. No part of this fee shall be returned
4796	to the facility. The agency may adjust the per bed license fee
4797	and the annual license fee once each year by not more than the
4798	average rate of inflation for the 12 months immediately
4799	preceding the increase.
4800	(c)  In addition to the total fee assessed under paragraph
4801	(a), the agency shall require facilities that are licensed to
4802	provide limited nursing services under this part to pay an
4803	additional fee per licensed facility. The amount of the biennial
4804	fee shall be $250 per license, with an additional fee of $10 per
4805	resident based on the total licensed resident capacity of the
4806	facility. No part of this fee shall be returned to the facility.
4807	The agency may adjust the per bed license fee and the biennial
4808	license fee once each year by not more than the average rate of
4809	inflation for the 12 months immediately preceding the increase.
4810	(5)  Counties or municipalities applying for licenses under
4811	this part are exempt from the payment of license fees.
4812	(6)  The license shall be displayed in a conspicuous place
4813	inside the facility.
4814	(7)  A license shall be valid only in the possession of the
4815	individual, firm, partnership, association, or corporation to
4816	which it is issued and shall not be subject to sale, assignment,
4817	or other transfer, voluntary or involuntary; nor shall a license
4818	be valid for any premises other than that for which originally
4819	issued.
4820	(8)  A fee may be charged to a facility requesting a
4821	duplicate license. The fee shall not exceed the actual cost of
4822	duplication and postage.
4823	Section 86.  Subsection (1) of section 400.4075, Florida
4824	Statutes, is amended to read:
4825	400.4075  Limited mental health license.--An assisted
4826	living facility that serves three or more mental health
4827	residents must obtain a limited mental health license.
4828	(1)  To obtain a limited mental health license, a facility
4829	must hold a standard license as an assisted living facility,
4830	must not have any current uncorrected deficiencies or
4831	violations, and must ensure that, within 6 months after
4832	receiving a limited mental health license, the facility
4833	administrator and the staff of the facility who are in direct
4834	contact with mental health residents must complete training of
4835	no less than 6 hours related to their duties. Such designation
4836	may be made at the time of initial licensure or relicensure or
4837	upon request in writing by a licensee under this part and part
4838	II of chapter 408. Notification of approval or denial of such
4839	request shall be made in accordance with this part, part II of
4840	chapter 408, and applicable rules. This training will be
4841	provided by or approved by the Department of Children and Family
4842	Services.
4843	Section 87.  Section 400.408, Florida Statutes, is amended
4844	to read:
4845	400.408  Unlicensed facilities; referral of person for
4846	residency to unlicensed facility; penalties; verification of
4847	licensure status.--
4848	(1)(a)  It is unlawful to own, operate, or maintain an
4849	assisted living facility without obtaining a license under this
4850	part.
4851	(b)  Except as provided under paragraph (d), any person who
4852	owns, operates, or maintains an unlicensed assisted living
4853	facility commits a felony of the third degree, punishable as
4854	provided in s. 775.082, s. 775.083, or s. 775.084. Each day of
4855	continued operation is a separate offense.
4856	(c)  Any person found guilty of violating paragraph (a) a
4857	second or subsequent time commits a felony of the second degree,
4858	punishable as provided under s. 775.082, s. 775.083, or s.
4859	775.084. Each day of continued operation is a separate offense.
4860	(d)  Any person who owns, operates, or maintains an
4861	unlicensed assisted living facility due to a change in this part
4862	or a modification in department rule within 6 months after the
4863	effective date of such change and who, within 10 working days
4864	after receiving notification from the agency, fails to cease
4865	operation or apply for a license under this part commits a
4866	felony of the third degree, punishable as provided in s.
4867	775.082, s. 775.083, or s. 775.084. Each day of continued
4868	operation is a separate offense.
4869	(e)  Any facility that fails to cease operation after
4870	agency notification may be fined for each day of noncompliance
4871	pursuant to s. 400.419.
4872	(f)  When a licensee has an interest in more than one
4873	assisted living facility, and fails to license any one of these
4874	facilities, the agency may revoke the license, impose a
4875	moratorium, or impose a fine pursuant to s. 400.419, on any or
4876	all of the licensed facilities until such time as the unlicensed
4877	facility is licensed or ceases operation.
4878	(g)  If the agency determines that an owner is operating or
4879	maintaining an assisted living facility without obtaining a
4880	license and determines that a condition exists in the facility
4881	that poses a threat to the health, safety, or welfare of a
4882	resident of the facility, the owner is subject to the same
4883	actions and fines imposed against a licensed facility as
4884	specified in ss. 400.414 and 400.419.
4885	(h)  Any person aware of the operation of an unlicensed
4886	assisted living facility must report that facility to the
4887	agency. The agency shall provide to the department's elder
4888	information and referral providers a list, by county, of
4889	licensed assisted living facilities, to assist persons who are
4890	considering an assisted living facility placement in locating a
4891	licensed facility.
4892	(2)(i)  Each field office of the Agency for Health Care
4893	Administration shall establish a local coordinating workgroup
4894	which includes representatives of local law enforcement
4895	agencies, state attorneys, the Medicaid Fraud Control Unit of
4896	the Department of Legal Affairs, local fire authorities, the
4897	Department of Children and Family Services, the district long-
4898	term care ombudsman council, and the district human rights
4899	advocacy committee to assist in identifying the operation of
4900	unlicensed facilities and to develop and implement a plan to
4901	ensure effective enforcement of state laws relating to such
4902	facilities. The workgroup shall report its findings, actions,
4903	and recommendations semiannually to the Director of Health
4904	Facility Regulation of the agency.
4905	(3)(2)  It is unlawful to knowingly refer a person for
4906	residency to an unlicensed assisted living facility; to an
4907	assisted living facility the license of which is under denial or
4908	has been suspended or revoked; or to an assisted living facility
4909	that has a moratorium pursuant to part II of chapter 408, on
4910	admissions. Any person who violates this subsection commits a
4911	noncriminal violation, punishable by a fine not exceeding $500
4912	as provided in s. 775.083.
4913	(a)  Any health care practitioner, as defined in s.
4914	456.001, who is aware of the operation of an unlicensed facility
4915	shall report that facility to the agency. Failure to report a
4916	facility that the practitioner knows or has reasonable cause to
4917	suspect is unlicensed shall be reported to the practitioner's
4918	licensing board.
4919	(b)  Any hospital or community mental health center
4920	licensed under chapter 395 or chapter 394 which knowingly
4921	discharges a patient or client to an unlicensed facility is
4922	subject to sanction by the agency.
4923	(c)  Any employee of the agency or department, or the
4924	Department of Children and Family Services, who knowingly refers
4925	a person for residency to an unlicensed facility; to a facility
4926	the license of which is under denial or has been suspended or
4927	revoked; or to a facility that has a moratorium pursuant to part
4928	II of chapter 408 on admissions is subject to disciplinary
4929	action by the agency or department, or the Department of
4930	Children and Family Services.
4931	(d)  The employer of any person who is under contract with
4932	the agency or department, or the Department of Children and
4933	Family Services, and who knowingly refers a person for residency
4934	to an unlicensed facility; to a facility the license of which is
4935	under denial or has been suspended or revoked; or to a facility
4936	that has a moratorium pursuant to part II of chapter 408 on
4937	admissions shall be fined and required to prepare a corrective
4938	action plan designed to prevent such referrals.
4939	(e)  The agency shall provide the department and the
4940	Department of Children and Family Services with a list of
4941	licensed facilities within each county and shall update the list
4942	at least quarterly.
4943	(f)  At least annually, the agency shall notify, in
4944	appropriate trade publications, physicians licensed under
4945	chapter 458 or chapter 459, hospitals licensed under chapter
4946	395, nursing home facilities licensed under part II of this
4947	chapter, and employees of the agency or the department, or the
4948	Department of Children and Family Services, who are responsible
4949	for referring persons for residency, that it is unlawful to
4950	knowingly refer a person for residency to an unlicensed assisted
4951	living facility and shall notify them of the penalty for
4952	violating such prohibition. The department and the Department of
4953	Children and Family Services shall, in turn, notify service
4954	providers under contract to the respective departments who have
4955	responsibility for resident referrals to facilities. Further,
4956	the notice must direct each noticed facility and individual to
4957	contact the appropriate agency office in order to verify the
4958	licensure status of any facility prior to referring any person
4959	for residency. Each notice must include the name, telephone
4960	number, and mailing address of the appropriate office to
4961	contact.
4962	Section 88.  Section 400.411, Florida Statutes, is amended
4963	to read:
4964	400.411  Initial application for license; provisional
4965	license.--
4966	(1)  Each applicant for licensure must comply with all
4967	provisions of part II of chapter 408 and must: Application for a
4968	license shall be made to the agency on forms furnished by it and
4969	shall be accompanied by the appropriate license fee.
4970	(2)  The applicant may be an individual owner, a
4971	corporation, a partnership, a firm, an association, or a
4972	governmental entity.
4973	(3)  The application must be signed by the applicant under
4974	oath and must contain the following:
4975	(a)  The name, address, date of birth, and social security
4976	number of the applicant and the name by which the facility is to
4977	be known. If the applicant is a firm, partnership, or
4978	association, the application shall contain the name, address,
4979	date of birth, and social security number of every member
4980	thereof. If the applicant is a corporation, the application
4981	shall contain the corporation's name and address; the name,
4982	address, date of birth, and social security number of each of
4983	its directors and officers; and the name and address of each
4984	person having at least a 5-percent ownership interest in the
4985	corporation.
4986	(b)  The name and address of any professional service,
4987	firm, association, partnership, or corporation that is to
4988	provide goods, leases, or services to the facility if a 5-
4989	percent or greater ownership interest in the service, firm,
4990	association, partnership, or corporation is owned by a person
4991	whose name must be listed on the application under paragraph
4992	(a).
4993	(c)  The name and address of any long-term care facility
4994	with which the applicant, administrator, or financial officer
4995	has been affiliated through ownership or employment within 5
4996	years of the date of this license application; and a signed
4997	affidavit disclosing any financial or ownership interest that
4998	the applicant, or any person listed in paragraph (a), holds or
4999	has held within the last 5 years in any facility licensed under
5000	this part, or in any other entity licensed by this state or
5001	another state to provide health or residential care, which
5002	facility or entity closed or ceased to operate as a result of
5003	financial problems, or has had a receiver appointed or a license
5004	denied, suspended or revoked, or was subject to a moratorium on
5005	admissions, or has had an injunctive proceeding initiated
5006	against it.
5007	(d)  A description and explanation of any exclusions,
5008	permanent suspensions, or terminations of the applicant from the
5009	Medicare or Medicaid programs. Proof of compliance with
5010	disclosure of ownership and control interest requirements of the
5011	Medicaid or Medicare programs shall be accepted in lieu of this
5012	submission.
5013	(e)  The names and addresses of persons of whom the agency
5014	may inquire as to the character, reputation, and financial
5015	responsibility of the owner and, if different from the
5016	applicant, the administrator and financial officer.
5017	(a)(f)  Identify Identification of all other homes or
5018	facilities, including the addresses and the license or licenses
5019	under which they operate, if applicable, which are currently
5020	operated by the applicant or administrator and which provide
5021	housing, meals, and personal services to residents.
5022	(b)(g)  Provide the location of the facility for which a
5023	license is sought and documentation, signed by the appropriate
5024	local government official, which states that the applicant has
5025	met local zoning requirements.
5026	(c)(h)  Provide the name, address, date of birth, social
5027	security number, education, and experience of the administrator,
5028	if different from the applicant.
5029	(4)  The applicant shall furnish satisfactory proof of
5030	financial ability to operate and conduct the facility in
5031	accordance with the requirements of this part. A certificate of
5032	authority, pursuant to chapter 651, may be provided as proof of
5033	financial ability.
5034	(5)  If the applicant is a continuing care facility
5035	certified under chapter 651, a copy of the facility's
5036	certificate of authority must be provided.
5037	(2)(6)  In addition to the requirements of s. 408.810, the
5038	applicant shall provide proof of liability insurance as defined
5039	in s. 624.605.
5040	(7)  If the applicant is a community residential home, the
5041	applicant must provide proof that it has met the requirements
5042	specified in chapter 419.
5043	(8)  The applicant must provide the agency with proof of
5044	legal right to occupy the property.
5045	(3)(9)  The applicant must furnish proof that the facility
5046	has received a satisfactory firesafety inspection. The local
5047	authority having jurisdiction or the State Fire Marshal must
5048	conduct the inspection within 30 days after written request by
5049	the applicant.
5050	(4)(10)  The applicant must furnish documentation of a
5051	satisfactory sanitation inspection of the facility by the county
5052	health department.
5053	(11)  The applicant must furnish proof of compliance with
5054	level 2 background screening as required under s. 400.4174.
5055	(5)(12)  A provisional license may be issued to an
5056	applicant making initial application for licensure or making
5057	application for a change of ownership. A provisional license
5058	shall be limited in duration to a specific period of time not to
5059	exceed 6 months, as determined by the agency.
5060	(6)(13)  A county or municipality may not issue an
5061	occupational license that is being obtained for the purpose of
5062	operating a facility regulated under this part without first
5063	ascertaining that the applicant has been licensed to operate
5064	such facility at the specified location or locations by the
5065	agency. The agency shall furnish to local agencies responsible
5066	for issuing occupational licenses sufficient instruction for
5067	making such determinations.
5068	Section 89.  Section 400.412, Florida Statutes, is amended
5069	to read:
5070	400.412  Sale or transfer of ownership of a facility.--It
5071	is the intent of the Legislature to protect the rights of the
5072	residents of an assisted living facility when the facility is
5073	sold or the ownership thereof is transferred. Therefore, in
5074	addition to the requirements of part II of chapter 408, whenever
5075	a facility is sold or the ownership thereof is transferred,
5076	including leasing:
5077	(1)  The transferee shall make application to the agency
5078	for a new license at least 60 days before the date of transfer
5079	of ownership. The application must comply with the provisions of
5080	s. 400.411.
5081	(2)(a)  The transferor shall notify the agency in writing
5082	at least 60 days before the date of transfer of ownership.
5083	(1)(b)  The transferee new owner shall notify the
5084	residents, in writing, of the change transfer of ownership
5085	within 7 days after of his or her receipt of the new license.
5086	(3)  The transferor shall be responsible and liable for:
5087	(a)  The lawful operation of the facility and the welfare
5088	of the residents domiciled in the facility until the date the
5089	transferee is licensed by the agency.
5090	(b)  Any and all penalties imposed against the facility for
5091	violations occurring before the date of transfer of ownership
5092	unless the penalty imposed is a moratorium on admissions or
5093	denial of licensure. The moratorium on admissions or denial of
5094	licensure remains in effect after the transfer of ownership,
5095	unless the agency has approved the transferee's corrective
5096	action plan or the conditions which created the moratorium or
5097	denial have been corrected, and may be grounds for denial of
5098	license to the transferee in accordance with chapter 120.
5099	(c)  Any outstanding liability to the state, unless the
5100	transferee has agreed, as a condition of sale or transfer, to
5101	accept the outstanding liabilities and to guarantee payment
5102	therefor; except that, if the transferee fails to meet these
5103	obligations, the transferor shall remain liable for the
5104	outstanding liability.
5105	(2)(4)  The transferor of a facility the license of which
5106	is denied pending an administrative hearing shall, as a part of
5107	the written change of ownership transfer-of-ownership contract,
5108	advise the transferee that a plan of correction must be
5109	submitted by the transferee and approved by the agency at least
5110	7 days before the change transfer of ownership and that failure
5111	to correct the condition which resulted in the moratorium
5112	pursuant to part II of chapter 408 on admissions or denial of
5113	licensure is grounds for denial of the transferee's license.
5114	(5)  The transferee must provide the agency with proof of
5115	legal right to occupy the property before a license may be
5116	issued. Proof may include, but is not limited to, copies of
5117	warranty deeds, or copies of lease or rental agreements,
5118	contracts for deeds, quitclaim deeds, or other such
5119	documentation.
5120	Section 90.  Section 400.414, Florida Statutes, is amended
5121	to read:
5122	400.414  Denial, revocation, or suspension of license;
5123	moratorium; imposition of administrative fine; grounds.--
5124	(1)  The agency may deny, revoke, and or suspend any
5125	license issued under this part and, or impose a moratorium and
5126	an administrative fine in the manner provided in chapter 120 on
5127	an assisted living facility for a violation of any provision of
5128	this part, part II of chapter 408, or applicable rules, or for
5129	any of the following actions by an assisted living facility, for
5130	the actions of any person subject to level 2 background
5131	screening under s. 408.809 400.4174, or for the actions of any
5132	facility employee:
5133	(a)  An intentional or negligent act seriously affecting
5134	the health, safety, or welfare of a resident of the facility.
5135	(b)  The determination by the agency that the owner lacks
5136	the financial ability to provide continuing adequate care to
5137	residents.
5138	(c)  Misappropriation or conversion of the property of a
5139	resident of the facility.
5140	(d)  Failure to follow the criteria and procedures provided
5141	under part I of chapter 394 relating to the transportation,
5142	voluntary admission, and involuntary examination of a facility
5143	resident.
5144	(e)  A citation of any of the following deficiencies as
5145	defined in s. 400.419:
5146	1.  One or more cited class I deficiencies.
5147	2.  Three or more cited class II deficiencies.
5148	3.  Five or more cited class III deficiencies that have
5149	been cited on a single survey and have not been corrected within
5150	the times specified.
5151	(f)  A determination that a person subject to level 2
5152	background screening under s. 408.809 400.4174(1) does not meet
5153	the screening standards of s. 435.04 or that the facility is
5154	retaining an employee subject to level 1 background screening
5155	standards under s. 400.4174(2) who does not meet the screening
5156	standards of s. 435.03 and for whom exemptions from
5157	disqualification have not been provided by the agency.
5158	(g)  A determination that an employee, volunteer,
5159	administrator, or owner, or person who otherwise has access to
5160	the residents of a facility does not meet the criteria specified
5161	in s. 435.03(2), and the owner or administrator has not taken
5162	action to remove the person. Exemptions from disqualification
5163	may be granted as set forth in s. 435.07. No administrative
5164	action may be taken against the facility if the person is
5165	granted an exemption.
5166	(h)  Violation of a moratorium.
5167	(i)  Failure of the license applicant, the licensee during
5168	relicensure, or a licensee that holds a provisional license to
5169	meet the minimum license requirements of this part, or related
5170	rules, at the time of license application or renewal.
5171	(j)  A fraudulent statement or omission of any material
5172	fact on an application for a license or any other document
5173	required by the agency, including the submission of a license
5174	application that conceals the fact that any board member,
5175	officer, or person owning 5 percent or more of the facility may
5176	not meet the background screening requirements of s. 400.4174,
5177	or that the applicant has been excluded, permanently suspended,
5178	or terminated from the Medicaid or Medicare programs.
5179	(h)(k)  An intentional or negligent life-threatening act in
5180	violation of the uniform firesafety standards for assisted
5181	living facilities or other firesafety standards that threatens
5182	the health, safety, or welfare of a resident of a facility, as
5183	communicated to the agency by the local authority having
5184	jurisdiction or the State Fire Marshal.
5185	(l)  Exclusion, permanent suspension, or termination from
5186	the Medicare or Medicaid programs.
5187	(i)(m)  Knowingly operating any unlicensed facility or
5188	providing without a license any service that must be licensed
5189	under this chapter.
5190	(j)(n)  Any act constituting a ground upon which
5191	application for a license may be denied.
5192
5193	Administrative proceedings challenging agency action under this
5194	subsection shall be reviewed on the basis of the facts and
5195	conditions that resulted in the agency action.
5196	(2)  Upon notification by the local authority having
5197	jurisdiction or by the State Fire Marshal, the agency may deny
5198	or revoke the license of an assisted living facility that fails
5199	to correct cited fire code violations that affect or threaten
5200	the health, safety, or welfare of a resident of a facility.
5201	(3)  The agency may deny a license to any applicant or
5202	controlling interest as defined in part II of chapter 408 that
5203	to any officer or board member of an applicant who is a firm,
5204	corporation, partnership, or association or who owns 5 percent
5205	or more of the facility, if the applicant, officer, or board
5206	member has or had a 25-percent or greater financial or ownership
5207	interest in any other facility licensed under this part, or in
5208	any entity licensed by this state or another state to provide
5209	health or residential care, which facility or entity during the
5210	5 years prior to the application for a license closed due to
5211	financial inability to operate; had a receiver appointed or a
5212	license denied, suspended, or revoked; was subject to a
5213	moratorium pursuant to part II of chapter 408 on admissions; had
5214	an injunctive proceeding initiated against it; or has an
5215	outstanding fine assessed under this chapter.
5216	(4)  The agency shall deny or revoke the license of an
5217	assisted living facility that has two or more class I violations
5218	that are similar or identical to violations identified by the
5219	agency during a survey, inspection, monitoring visit, or
5220	complaint investigation occurring within the previous 2 years.
5221	(5)  An action taken by the agency to suspend, deny, or
5222	revoke a facility's license under this part, in which the agency
5223	claims that the facility owner or an employee of the facility
5224	has threatened the health, safety, or welfare of a resident of
5225	the facility be heard by the Division of Administrative Hearings
5226	of the Department of Management Services within 120 days after
5227	receipt of the facility's request for a hearing, unless that
5228	time limitation is waived by both parties. The administrative
5229	law judge must render a decision within 30 days after receipt of
5230	a proposed recommended order.
5231	(6)  The agency shall provide to the Division of Hotels and
5232	Restaurants of the Department of Business and Professional
5233	Regulation, on a monthly basis, a list of those assisted living
5234	facilities that have had their licenses denied, suspended, or
5235	revoked or that are involved in an appellate proceeding pursuant
5236	to s. 120.60 related to the denial, suspension, or revocation of
5237	a license.
5238	(7)  Agency notification of a license suspension or
5239	revocation, or denial of a license renewal, shall be posted and
5240	visible to the public at the facility.
5241	(8)  The agency may issue a temporary license pending final
5242	disposition of a proceeding involving the suspension or
5243	revocation of an assisted living facility license.
5244	Section 91.  Section 400.415, Florida Statutes, is
5245	repealed.
5246	Section 92.  Section 400.417, Florida Statutes, is amended
5247	to read:
5248	400.417  Expiration of license; renewal; conditional
5249	license.--
5250	(1)  Biennial licenses, unless sooner suspended or revoked,
5251	shall expire 2 years from the date of issuance. Limited nursing,
5252	extended congregate care, and limited mental health licenses
5253	shall expire at the same time as the facility's standard
5254	license, regardless of when issued. The agency shall notify the
5255	facility at least 120 days prior to expiration that a renewal
5256	license is necessary to continue operation. The notification
5257	must be provided electronically or by mail delivery. Ninety days
5258	prior to the expiration date, an application for renewal shall
5259	be submitted to the agency. Fees must be prorated. The failure
5260	to file a timely renewal application shall result in a late fee
5261	charged to the facility in an amount equal to 50 percent of the
5262	current fee.
5263	(2)  A license shall be renewed in accordance with part II
5264	of chapter 408 within 90 days upon the timely filing of an
5265	application on forms furnished by the agency and the provision
5266	of satisfactory proof of ability to operate and conduct the
5267	facility in accordance with the requirements of this part and
5268	adopted rules, including proof that the facility has received a
5269	satisfactory firesafety inspection, conducted by the local
5270	authority having jurisdiction or the State Fire Marshal, within
5271	the preceding 12 months and an affidavit of compliance with the
5272	background screening requirements of s. 400.4174.
5273	(3)  In addition to the requirements of part II of chapter
5274	408, An applicant for renewal of a license who has complied with
5275	the provisions of s. 400.411 with respect to proof of financial
5276	ability to operate shall not be required to provide further
5277	proof unless the facility or any other facility owned or
5278	operated in whole or in part by the same person has demonstrated
5279	financial instability as provided under s. 400.447(2) or unless
5280	the agency suspects that the facility is not financially stable
5281	as a result of the annual survey or complaints from the public
5282	or a report from the State Long-Term Care Ombudsman Council.
5283	each facility must report to the agency any adverse court action
5284	concerning the facility's financial viability, within 7 days
5285	after its occurrence. The agency shall have access to books,
5286	records, and any other financial documents maintained by the
5287	facility to the extent necessary to determine the facility's
5288	financial stability. A license for the operation of a facility
5289	shall not be renewed if the licensee has any outstanding fines
5290	assessed pursuant to this part which are in final order status.
5291	(4)  A licensee against whom a revocation or suspension
5292	proceeding is pending at the time of license renewal may be
5293	issued a conditional license effective until final disposition
5294	by the agency. If judicial relief is sought from the final
5295	disposition, the court having jurisdiction may issue a
5296	conditional license for the duration of the judicial proceeding.
5297	(4)(5)  A conditional license may be issued to an applicant
5298	for license renewal if the applicant fails to meet all standards
5299	and requirements for licensure. A conditional license issued
5300	under this subsection shall be limited in duration to a specific
5301	period of time not to exceed 6 months, as determined by the
5302	agency, and shall be accompanied by an agency-approved plan of
5303	correction.
5304	(5)(6)  When an extended care or limited nursing license is
5305	requested during a facility's biennial license period, the fee
5306	shall be prorated in order to permit the additional license to
5307	expire at the end of the biennial license period. The fee shall
5308	be calculated as of the date the additional license application
5309	is received by the agency.
5310	(6)(7)  The agency department may by rule establish renewal
5311	procedures, identify forms, and specify documentation necessary
5312	to administer this section and part II of chapter 408.
5313	Section 93.  Section 400.4174, Florida Statutes, is amended
5314	to read:
5315	400.4174  Background screening; exemptions.--
5316	(1)(a)  Level 2 background screening must be conducted on
5317	each of the following persons, who shall be considered employees
5318	for the purposes of conducting screening under chapter 435:
5319	1.  The facility owner if an individual, the administrator,
5320	and the financial officer.
5321	2.  An officer or board member if the facility owner is a
5322	firm, corporation, partnership, or association, or any person
5323	owning 5 percent or more of the facility if the agency has
5324	probable cause to believe that such person has been convicted of
5325	any offense prohibited by s. 435.04. For each officer, board
5326	member, or person owning 5 percent or more who has been
5327	convicted of any such offense, the facility shall submit to the
5328	agency a description and explanation of the conviction at the
5329	time of license application. This subparagraph does not apply to
5330	a board member of a not-for-profit corporation or organization
5331	if the board member serves solely in a voluntary capacity, does
5332	not regularly take part in the day-to-day operational decisions
5333	of the corporation or organization, receives no remuneration for
5334	his or her services, and has no financial interest and has no
5335	family members with a financial interest in the corporation or
5336	organization, provided that the board member and facility submit
5337	a statement affirming that the board member's relationship to
5338	the facility satisfies the requirements of this subparagraph.
5339	(b)  Proof of compliance with level 2 screening standards
5340	which has been submitted within the previous 5 years to meet any
5341	facility or professional licensure requirements of the agency or
5342	the Department of Health satisfies the requirements of this
5343	subsection, provided that such proof is accompanied, under
5344	penalty of perjury, by an affidavit of compliance with the
5345	provisions of chapter 435. Proof of compliance with the
5346	background screening requirements of the Financial Services
5347	Commission and the Office of Insurance Regulation for applicants
5348	for a certificate of authority to operate a continuing care
5349	retirement community under chapter 651, submitted within the
5350	last 5 years, satisfies the Department of Law Enforcement and
5351	Federal Bureau of Investigation portions of a level 2 background
5352	check.
5353	(c)  The agency may grant a provisional license to a
5354	facility applying for an initial license when each individual
5355	required by this subsection to undergo screening has completed
5356	the Department of Law Enforcement background checks, but has not
5357	yet received results from the Federal Bureau of Investigation,
5358	or when a request for an exemption from disqualification has
5359	been submitted to the agency pursuant to s. 435.07, but a
5360	response has not been issued.
5361	(2)  The owner or administrator of an assisted living
5362	facility must conduct level 1 background screening, as set forth
5363	in chapter 435, on all employees hired on or after October 1,
5364	1998, who perform personal services as defined in s.
5365	400.402(16)(17). The agency may exempt an individual from
5366	employment disqualification as set forth in chapter 435. Such
5367	persons shall be considered as having met this requirement if:
5368	(1)(a)  Proof of compliance with level 1 screening
5369	requirements obtained to meet any professional license
5370	requirements in this state is provided and accompanied, under
5371	penalty of perjury, by a copy of the person's current
5372	professional license and an affidavit of current compliance with
5373	the background screening requirements.
5374	(2)(b)  The person required to be screened has been
5375	continuously employed in the same type of occupation for which
5376	the person is seeking employment without a breach in service
5377	which exceeds 180 days, and proof of compliance with the level 1
5378	screening requirement which is no more than 2 years old is
5379	provided. Proof of compliance shall be provided directly from
5380	one employer or contractor to another, and not from the person
5381	screened. Upon request, a copy of screening results shall be
5382	provided by the employer retaining documentation of the
5383	screening to the person screened.
5384	(3)(c)  The person required to be screened is employed by a
5385	corporation or business entity or related corporation or
5386	business entity that owns, operates, or manages more than one
5387	facility or agency licensed under this chapter, and for whom a
5388	level 1 screening was conducted by the corporation or business
5389	entity as a condition of initial or continued employment.
5390	Section 94.  Section 400.4176, Florida Statutes, is amended
5391	to read:
5392	400.4176  Notice of change of administrator.--If, during
5393	the period for which a license is issued, the owner changes
5394	administrators, the owner must notify the agency of the change
5395	within 10 days and provide documentation within 90 days that the
5396	new administrator has completed the applicable core educational
5397	requirements under s. 400.452. Background screening shall be
5398	completed on any new administrator as specified in s. 400.4174.
5399	Section 95.  Subsection (8) of section 400.4178, Florida
5400	Statutes, is renumbered as subsection (7) and present subsection
5401	(7) of said section is amended to read:
5402	400.4178  Special care for persons with Alzheimer's disease
5403	or other related disorders.--
5404	(7)  Any facility more than 90 percent of whose residents
5405	receive monthly optional supplementation payments is not
5406	required to pay for the training and education programs required
5407	under this section. A facility that has one or more such
5408	residents shall pay a reduced fee that is proportional to the
5409	percentage of such residents in the facility. A facility that
5410	does not have any residents who receive monthly optional
5411	supplementation payments must pay a reasonable fee, as
5412	established by the department, for such training and education
5413	programs.
5414	Section 96.  Section 400.418, Florida Statutes, is amended
5415	to read:
5416	400.418  Disposition of fees and administrative fines.--
5417	(1)  Income from license fees, inspection fees, late fees,
5418	and administrative fines collected under this part generated
5419	pursuant to ss. 400.407, 400.408, 400.417, 400.419, and 400.431
5420	shall be deposited in the Health Care Trust Fund administered by
5421	the agency. Such funds shall be directed to and used by the
5422	agency for the following purposes:
5423	(1)(a)  Up to 50 percent of the trust funds accrued each
5424	fiscal year under this part may be used to offset the expenses
5425	of receivership, pursuant to s. 400.422, if the court determines
5426	that the income and assets of the facility are insufficient to
5427	provide for adequate management and operation.
5428	(2)(b)  An amount of $5,000 of the trust funds accrued each
5429	year under this part shall be allocated to pay for inspection-
5430	related physical and mental health examinations requested by the
5431	agency pursuant to s. 400.426 for residents who are either
5432	recipients of supplemental security income or have monthly
5433	incomes not in excess of the maximum combined federal and state
5434	cash subsidies available to supplemental security income
5435	recipients, as provided for in s. 409.212. Such funds shall only
5436	be used where the resident is ineligible for Medicaid.
5437	(3)(c)  Any trust funds accrued each year under this part
5438	and not used for the purposes specified in subsections (1) and
5439	(2) paragraphs (a) and (b) shall be used to offset the costs of
5440	the licensure program, including the costs of conducting
5441	background investigations, verifying information submitted,
5442	defraying the costs of processing the names of applicants, and
5443	conducting inspections and monitoring visits pursuant to this
5444	part and part II of chapter 408.
5445	(2)  Income from fees generated pursuant to s. 400.441(5)
5446	shall be deposited in the Health Care Trust Fund and used to
5447	offset the costs of printing and postage.
5448	Section 97.  Section 400.419, Florida Statutes, is amended
5449	to read:
5450	400.419  Violations; imposition of administrative fines;
5451	grounds.--
5452	(1)  The agency shall impose an administrative fine in the
5453	manner provided in chapter 120 for the violation of any
5454	provision of this part, part II of chapter 408, and applicable
5455	rules for any of the actions or violations as set forth within
5456	this section by an assisted living facility, for the actions of
5457	any person subject to level 2 background screening under s.
5458	400.4174, for the actions of any facility employee, or for an
5459	intentional or negligent act seriously affecting the health,
5460	safety, or welfare of a resident of the facility.
5461	(2)  Each violation of this part and adopted rules shall be
5462	classified according to the nature of the violation and the
5463	gravity of its probable effect on facility residents. The agency
5464	shall indicate the classification on the written notice of the
5465	violation as follows:
5466	(a)  Class "I" violations are those conditions or
5467	occurrences related to the operation and maintenance of a
5468	facility or to the personal care of residents which the agency
5469	determines present an imminent danger to the residents or guests
5470	of the facility or a substantial probability that death or
5471	serious physical or emotional harm would result therefrom. The
5472	condition or practice constituting a class I violation shall be
5473	abated or eliminated within 24 hours, unless a fixed period, as
5474	determined by the agency, is required for correction. The agency
5475	shall impose an administrative fine for a cited class I
5476	violation in an amount not less than $5,000 and not exceeding
5477	$10,000 for each violation. A fine may be levied notwithstanding
5478	the correction of the violation.
5479	(b)  Class "II" violations are those conditions or
5480	occurrences related to the operation and maintenance of a
5481	facility or to the personal care of residents which the agency
5482	determines directly threaten the physical or emotional health,
5483	safety, or security of the facility residents, other than class
5484	I violations. The agency shall impose an administrative fine for
5485	a cited class II violation in an amount not less than $1,000 and
5486	not exceeding $5,000 for each violation. A fine shall be levied
5487	notwithstanding the correction of the violation.
5488	(c)  Class "III" violations are those conditions or
5489	occurrences related to the operation and maintenance of a
5490	facility or to the personal care of residents which the agency
5491	determines indirectly or potentially threaten the physical or
5492	emotional health, safety, or security of facility residents,
5493	other than class I or class II violations. The agency shall
5494	impose an administrative fine for a cited class III violation in
5495	an amount not less than $500 and not exceeding $1,000 for each
5496	violation. A citation for a class III violation must specify the
5497	time within which the violation is required to be corrected. If
5498	a class III violation is corrected within the time specified, no
5499	fine may be imposed, unless it is a repeated offense.
5500	(d)  Class "IV" violations are those conditions or
5501	occurrences related to the operation and maintenance of a
5502	building or to required reports, forms, or documents that do not
5503	have the potential of negatively affecting residents. These
5504	violations are of a type that the agency determines do not
5505	threaten the health, safety, or security of residents of the
5506	facility. The agency shall impose an administrative fine for a
5507	cited class IV violation in an amount not less than $100 and not
5508	exceeding $200 for each violation. A citation for a class IV
5509	violation must specify the time within which the violation is
5510	required to be corrected. If a class IV violation is corrected
5511	within the time specified, no fine shall be imposed. Any class
5512	IV violation that is corrected during the time an agency survey
5513	is being conducted will be identified as an agency finding and
5514	not as a violation.
5515	(3)  For purposes of this section, in determining if a
5516	penalty is to be imposed and in fixing the amount of the fine,
5517	the agency shall consider the following factors:
5518	(a)  The gravity of the violation, including the
5519	probability that death or serious physical or emotional harm to
5520	a resident will result or has resulted, the severity of the
5521	action or potential harm, and the extent to which the provisions
5522	of the applicable laws or rules were violated.
5523	(b)  Actions taken by the owner or administrator to correct
5524	violations.
5525	(c)  Any previous violations.
5526	(d)  The financial benefit to the facility of committing or
5527	continuing the violation.
5528	(e)  The licensed capacity of the facility.
5529	(4)  Each day of continuing violation after the date fixed
5530	for termination of the violation, as ordered by the agency,
5531	constitutes an additional, separate, and distinct violation.
5532	(5)  Any action taken to correct a violation shall be
5533	documented in writing by the owner or administrator of the
5534	facility and verified through followup visits by agency
5535	personnel. The agency may impose a fine and, in the case of an
5536	owner-operated facility, revoke or deny a facility's license
5537	when a facility administrator fraudulently misrepresents action
5538	taken to correct a violation.
5539	(6)  For fines that are upheld following administrative or
5540	judicial review, the violator shall pay the fine, plus interest
5541	at the rate as specified in s. 55.03, for each day beyond the
5542	date set by the agency for payment of the fine.
5543	(7)  Any unlicensed facility that continues to operate
5544	after agency notification is subject to a $1,000 fine per day.
5545	(8)  Any licensed facility whose owner or administrator
5546	concurrently operates an unlicensed facility shall be subject to
5547	an administrative fine of $5,000 per day.
5548	(9)  Any facility whose owner fails to apply for a change-
5549	of-ownership license in accordance with s. 400.412 and operates
5550	the facility under the new ownership is subject to a fine of
5551	$5,000.
5552	(6)(10)  In addition to any administrative fines imposed,
5553	the agency may assess a survey fee, equal to the lesser of one
5554	half of the facility's biennial license and bed fee or $500, to
5555	cover the cost of conducting initial complaint investigations
5556	that result in the finding of a violation that was the subject
5557	of the complaint or monitoring visits conducted under s.
5558	400.428(3)(c) to verify the correction of the violations.
5559	(7)(11)  The agency, as an alternative to or in conjunction
5560	with an administrative action against a facility for violations
5561	of this part and adopted rules, shall make a reasonable attempt
5562	to discuss each violation and recommended corrective action with
5563	the owner or administrator of the facility, prior to written
5564	notification. The agency, instead of fixing a period within
5565	which the facility shall enter into compliance with standards,
5566	may request a plan of corrective action from the facility which
5567	demonstrates a good faith effort to remedy each violation by a
5568	specific date, subject to the approval of the agency.
5569	(12)  Administrative fines paid by any facility under this
5570	section shall be deposited into the Health Care Trust Fund and
5571	expended as provided in s. 400.418.
5572	(8)(13)  The agency shall develop and disseminate an annual
5573	list of all facilities sanctioned or fined $5,000 or more for
5574	violations of state standards, the number and class of
5575	violations involved, the penalties imposed, and the current
5576	status of cases. The list shall be disseminated, at no charge,
5577	to the Department of Elderly Affairs, the Department of Health,
5578	the Department of Children and Family Services, the area
5579	agencies on aging, the Florida Statewide Advocacy Council, and
5580	the state and local ombudsman councils. The Department of
5581	Children and Family Services shall disseminate the list to
5582	service providers under contract to the department who are
5583	responsible for referring persons to a facility for residency.
5584	The agency may charge a fee commensurate with the cost of
5585	printing and postage to other interested parties requesting a
5586	copy of this list.
5587	Section 98.  Section 400.421, Florida Statutes, is
5588	repealed.
5589	Section 99.  Subsection (9) of section 400.422, Florida
5590	Statutes, is amended to read:
5591	400.422  Receivership proceedings.--
5592	(9)  The court may direct the agency to allocate funds from
5593	the Health Care Trust Fund to the receiver, subject to the
5594	provisions of s. 400.418(1).
5595	Section 100.  Subsection (10) of section 400.423, Florida
5596	Statutes, is amended to read:
5597	400.423  Internal risk management and quality assurance
5598	program; adverse incidents and reporting requirements.--
5599	(10)  The agency Department of Elderly Affairs may adopt
5600	rules necessary to administer this section.
5601	Section 101.  Subsections (3) and (8) of section 400.424,
5602	Florida Statutes, are amended to read:
5603	400.424  Contracts.--
5604	(3)(a)  The contract shall include a refund policy to be
5605	implemented at the time of a resident's transfer, discharge, or
5606	death. The refund policy shall provide that the resident or
5607	responsible party is entitled to a prorated refund based on the
5608	daily rate for any unused portion of payment beyond the
5609	termination date after all charges, including the cost of
5610	damages to the residential unit resulting from circumstances
5611	other than normal use, have been paid to the licensee. For the
5612	purpose of this paragraph, the termination date shall be the
5613	date the unit is vacated by the resident and cleared of all
5614	personal belongings. If the amount of belongings does not
5615	preclude renting the unit, the facility may clear the unit and
5616	charge the resident or his or her estate for moving and storing
5617	the items at a rate equal to the actual cost to the facility,
5618	not to exceed 20 percent of the regular rate for the unit,
5619	provided that 14 days' advance written notification is given. If
5620	the resident's possessions are not claimed within 45 days after
5621	notification, the facility may dispose of them. The contract
5622	shall also specify any other conditions under which claims will
5623	be made against the refund due the resident. Except in the case
5624	of death or a discharge due to medical reasons, the refunds
5625	shall be computed in accordance with the notice of relocation
5626	requirements specified in the contract. However, a resident may
5627	not be required to provide the licensee with more than 30 days'
5628	notice of termination. If after a contract is terminated, the
5629	facility intends to make a claim against a refund due the
5630	resident, the facility shall notify the resident or responsible
5631	party in writing of the claim and shall provide said party with
5632	a reasonable time period of no less than 14 calendar days to
5633	respond. The facility shall provide a refund to the resident or
5634	responsible party within 45 days after the transfer, discharge,
5635	or death of the resident. The agency shall impose a fine upon a
5636	facility that fails to comply with the refund provisions of this
5637	the paragraph, which fine shall be equal to three times the
5638	amount due to the resident and not subject to the provisions of
5639	s. 400.419(3). One-half of the fine shall be remitted to the
5640	resident or his or her estate, and the other half to the Health
5641	Care Trust Fund to be used for the purpose specified in s.
5642	400.418.
5643	(b)  If a licensee agrees to reserve a bed for a resident
5644	who is admitted to a medical facility, including, but not
5645	limited to, a nursing home, health care facility, or psychiatric
5646	facility, the resident or his or her responsible party shall
5647	notify the licensee of any change in status that would prevent
5648	the resident from returning to the facility. Until such notice
5649	is received, the agreed-upon daily rate may be charged by the
5650	licensee.
5651	(c)  The purpose of any advance payment and a refund policy
5652	for such payment, including any advance payment for housing,
5653	meals, or personal services, shall be covered in the contract.
5654	(8)  The agency department may by rule clarify terms,
5655	establish procedures, clarify refund policies and contract
5656	provisions, and specify documentation as necessary to administer
5657	this section.
5658	Section 102.  Subsection (3) of section 400.4255, Florida
5659	Statutes, is amended to read:
5660	400.4255  Use of personnel; emergency care.--
5661	(3)  Facility staff may withhold or withdraw
5662	cardiopulmonary resuscitation if presented with an order not to
5663	resuscitate executed pursuant to s. 401.45. The agency
5664	department shall adopt rules providing for the implementation of
5665	such orders. Facility staff and facilities shall not be subject
5666	to criminal prosecution or civil liability, nor be considered to
5667	have engaged in negligent or unprofessional conduct, for
5668	withholding or withdrawing cardiopulmonary resuscitation
5669	pursuant to such an order and applicable rules adopted by the
5670	department. The absence of an order to resuscitate executed
5671	pursuant to s. 401.45 does not preclude a physician from
5672	withholding or withdrawing cardiopulmonary resuscitation as
5673	otherwise permitted by law.
5674	Section 103.  Subsection (6) of section 400.4256, Florida
5675	Statutes, is amended to read:
5676	400.4256  Assistance with self-administration of
5677	medication.--
5678	(6)  The agency department may by rule establish facility
5679	procedures and interpret terms as necessary to implement this
5680	section.
5681	Section 104.  Subsection (9) of section 400.426, Florida
5682	Statutes, is amended to read:
5683	400.426  Appropriateness of placements; examinations of
5684	residents.--
5685	(9)  If, at any time after admission to a facility, a
5686	resident appears to need care beyond that which the facility is
5687	licensed to provide, the agency shall require the resident to be
5688	physically examined by a licensed physician or licensed nurse
5689	practitioner. This examination shall, to the extent possible, be
5690	performed by the resident's preferred physician or nurse
5691	practitioner and shall be paid for by the resident with personal
5692	funds, except as provided in s. 400.418(2)(1)(b). Following this
5693	examination, the examining physician or licensed nurse
5694	practitioner shall complete and sign a medical form provided by
5695	the agency. The completed medical form shall be submitted to the
5696	agency within 30 days after the date the facility owner or
5697	administrator is notified by the agency that the physical
5698	examination is required. After consultation with the physician
5699	or licensed nurse practitioner who performed the examination, a
5700	medical review team designated by the agency shall then
5701	determine whether the resident is appropriately residing in the
5702	facility. The medical review team shall base its decision on a
5703	comprehensive review of the resident's physical and functional
5704	status, including the resident's preferences, and not on an
5705	isolated health-related problem. In the case of a mental health
5706	resident, if the resident appears to have needs in addition to
5707	those identified in the community living support plan, the
5708	agency may require an evaluation by a mental health
5709	professional, as determined by the Department of Children and
5710	Family Services. A facility may not be required to retain a
5711	resident who requires more services or care than the facility is
5712	able to provide in accordance with its policies and criteria for
5713	admission and continued residency. Members of the medical review
5714	team making the final determination may not include the agency
5715	personnel who initially questioned the appropriateness of a
5716	resident's placement. Such determination is final and binding
5717	upon the facility and the resident. Any resident who is
5718	determined by the medical review team to be inappropriately
5719	residing in a facility shall be given 30 days' written notice to
5720	relocate by the owner or administrator, unless the resident's
5721	continued residence in the facility presents an imminent danger
5722	to the health, safety, or welfare of the resident or a
5723	substantial probability exists that death or serious physical
5724	harm would result to the resident if allowed to remain in the
5725	facility.
5726	Section 105.  Subsection (8) of section 400.427, Florida
5727	Statutes, is amended to read:
5728	400.427  Property and personal affairs of residents.--
5729	(8)  The agency department may by rule clarify terms and
5730	specify procedures and documentation necessary to administer the
5731	provisions of this section relating to the proper management of
5732	residents' funds and personal property and the execution of
5733	surety bonds.
5734	Section 106.  Subsection (4) of section 400.4275, Florida
5735	Statutes, is amended to read:
5736	400.4275  Business practice; personnel records; liability
5737	insurance.--The assisted living facility shall be administered
5738	on a sound financial basis that is consistent with good business
5739	practices.
5740	(4)  The agency department may by rule clarify terms,
5741	establish requirements for financial records, accounting
5742	procedures, personnel procedures, insurance coverage, and
5743	reporting procedures, and specify documentation as necessary to
5744	implement the requirements of this section.
5745	Section 107.  Subsections (1), (4), and (5) of section
5746	400.431, Florida Statutes, are amended to read:
5747	400.431  Closing of facility; notice; penalty.--
5748	(1)  In addition to the requirements of part II of chapter
5749	408, Whenever a facility voluntarily discontinues operation, it
5750	shall inform the agency in writing at least 90 days prior to the
5751	discontinuance of operation. the facility shall also inform each
5752	resident or the next of kin, legal representative, or agency
5753	acting on each resident's behalf, of the fact and the proposed
5754	time of such discontinuance of operation, following the
5755	notification requirements provided in s. 400.428(1)(k). In the
5756	event a resident has no person to represent him or her, the
5757	facility shall be responsible for referral to an appropriate
5758	social service agency for placement.
5759	(4)  Immediately upon discontinuance of the operation of a
5760	facility, the owner shall surrender the license therefor to the
5761	agency, and the license shall be canceled.
5762	(4)(5)  The agency may levy a fine in an amount no greater
5763	than $5,000 upon each person or business entity that owns any
5764	interest in a facility that terminates operation without
5765	providing notice to the agency and the residents of the facility
5766	at least 30 days before operation ceases. This fine shall not be
5767	levied against any facility involuntarily closed at the
5768	initiation of the agency. The agency shall use the proceeds of
5769	the fines to operate the facility until all residents of the
5770	facility are relocated and shall deposit any balance of the
5771	proceeds into the Health Care Trust Fund established pursuant to
5772	s. 400.418.
5773	Section 108.  Section 400.434, Florida Statutes, is amended
5774	to read:
5775	400.434  Right of entry and inspection.--Any duly
5776	designated officer or employee of the department, the Department
5777	of Children and Family Services, the agency, the Medicaid Fraud
5778	Control Unit of the Department of Legal Affairs, the state or
5779	local fire marshal, or a member of the state or local long-term
5780	care ombudsman council, or the agency in accordance with s.
5781	408.811 shall have the right to enter unannounced upon and into
5782	the premises of any facility licensed pursuant to this part in
5783	order to determine the state of compliance with the provisions
5784	of this part, part II of chapter 408, and of applicable rules or
5785	standards in force pursuant thereto. The right of entry and
5786	inspection shall also extend to any premises which the agency
5787	has reason to believe is being operated or maintained as a
5788	facility without a license; but no such entry or inspection of
5789	any premises may be made without the permission of the owner or
5790	person in charge thereof, unless a warrant is first obtained
5791	from the circuit court authorizing such entry. The warrant
5792	requirement shall extend only to a facility which the agency has
5793	reason to believe is being operated or maintained as a facility
5794	without a license. Any application for a license or renewal
5795	thereof made pursuant to this part shall constitute permission
5796	for, and complete acquiescence in, any entry or inspection of
5797	the premises for which the license is sought, in order to
5798	facilitate verification of the information submitted on or in
5799	connection with the application; to discover, investigate, and
5800	determine the existence of abuse or neglect; or to elicit,
5801	receive, respond to, and resolve complaints. Any current valid
5802	license shall constitute unconditional permission for, and
5803	complete acquiescence in, any entry or inspection of the
5804	premises by authorized personnel. The agency shall retain the
5805	right of entry and inspection of facilities that have had a
5806	license revoked or suspended within the previous 24 months, to
5807	ensure that the facility is not operating unlawfully. However,
5808	before entering the facility, a statement of probable cause must
5809	be filed with the director of the agency, who must approve or
5810	disapprove the action within 48 hours. Probable cause shall
5811	include, but is not limited to, evidence that the facility holds
5812	itself out to the public as a provider of personal care services
5813	or the receipt of a complaint by the long-term care ombudsman
5814	council about the facility. Data collected by the state or local
5815	long-term care ombudsman councils or the state or local advocacy
5816	councils may be used by the agency in investigations involving
5817	violations of regulatory standards.
5818	Section 109.  Subsections (2) and (3) of section 400.435,
5819	Florida Statutes, are renumbered as subsections (1) and (2),
5820	respectively, and present subsection (1) of said section is
5821	amended to read:
5822	400.435  Inspection Maintenance of records; reports.--
5823	(1)  Every facility shall maintain, as public information
5824	available for public inspection under such conditions as the
5825	agency shall prescribe, records containing copies of all
5826	inspection reports pertaining to the facility that have been
5827	issued by the agency to the facility. Copies of inspection
5828	reports shall be retained in the records for 5 years from the
5829	date the reports are filed or issued.
5830	(1)(2)  Within 60 days after the date of the biennial
5831	inspection visit required under s. 408.811 or within 30 days
5832	after the date of any interim visit, the agency shall forward
5833	the results of the inspection to the local ombudsman council in
5834	whose planning and service area, as defined in part II, the
5835	facility is located; to at least one public library or, in the
5836	absence of a public library, the county seat in the county in
5837	which the inspected assisted living facility is located; and,
5838	when appropriate, to the district Adult Services and Mental
5839	Health Program Offices.
5840	Section 110.  Section 400.441, Florida Statutes, is amended
5841	to read:
5842	400.441  Rules establishing standards.--
5843	(1)  It is the intent of the Legislature that rules
5844	published and enforced pursuant to this section shall include
5845	criteria by which a reasonable and consistent quality of
5846	resident care and quality of life may be ensured and the results
5847	of such resident care may be demonstrated. Such rules shall also
5848	ensure a safe and sanitary environment that is residential and
5849	noninstitutional in design or nature. It is further intended
5850	that reasonable efforts be made to accommodate the needs and
5851	preferences of residents to enhance the quality of life in a
5852	facility. In order to provide safe and sanitary facilities and
5853	the highest quality of resident care accommodating the needs and
5854	preferences of residents, the agency department, in consultation
5855	with the department agency, the Department of Children and
5856	Family Services, and the Department of Health, shall adopt
5857	rules, policies, and procedures to administer this part and part
5858	II of chapter 408, which must include reasonable and fair
5859	minimum standards in relation to:
5860	(a)  The requirements for and maintenance of facilities,
5861	not in conflict with the provisions of chapter 553, relating to
5862	plumbing, heating, cooling, lighting, ventilation, living space,
5863	and other housing conditions, which will ensure the health,
5864	safety, and comfort of residents and protection from fire
5865	hazard, including adequate provisions for fire alarm and other
5866	fire protection suitable to the size of the structure. Uniform
5867	firesafety standards shall be established and enforced by the
5868	State Fire Marshal in cooperation with the agency, the
5869	department, and the Department of Health.
5870	1.  Evacuation capability determination.--
5871	a.  The provisions of the National Fire Protection
5872	Association, NFPA 101A, Chapter 5, 1995 edition, shall be used
5873	for determining the ability of the residents, with or without
5874	staff assistance, to relocate from or within a licensed facility
5875	to a point of safety as provided in the fire codes adopted
5876	herein. An evacuation capability evaluation for initial
5877	licensure shall be conducted within 6 months after the date of
5878	licensure. For existing licensed facilities that are not
5879	equipped with an automatic fire sprinkler system, the
5880	administrator shall evaluate the evacuation capability of
5881	residents at least annually. The evacuation capability
5882	evaluation for each facility not equipped with an automatic fire
5883	sprinkler system shall be validated, without liability, by the
5884	State Fire Marshal, by the local fire marshal, or by the local
5885	authority having jurisdiction over firesafety, before the
5886	license renewal date. If the State Fire Marshal, local fire
5887	marshal, or local authority having jurisdiction over firesafety
5888	has reason to believe that the evacuation capability of a
5889	facility as reported by the administrator may have changed, it
5890	may, with assistance from the facility administrator, reevaluate
5891	the evacuation capability through timed exiting drills.
5892	Translation of timed fire exiting drills to evacuation
5893	capability may be determined:
5894	(I)  Three minutes or less: prompt.
5895	(II)  More than 3 minutes, but not more than 13 minutes:
5896	slow.
5897	(III)  More than 13 minutes: impractical.
5898	b.  The Office of the State Fire Marshal shall provide or
5899	cause the provision of training and education on the proper
5900	application of Chapter 5, NFPA 101A, 1995 edition, to its
5901	employees, to staff of the Agency for Health Care Administration
5902	who are responsible for regulating facilities under this part,
5903	and to local governmental inspectors. The Office of the State
5904	Fire Marshal shall provide or cause the provision of this
5905	training within its existing budget, but may charge a fee for
5906	this training to offset its costs. The initial training must be
5907	delivered within 6 months after July 1, 1995, and as needed
5908	thereafter.
5909	c.  The Office of the State Fire Marshal, in cooperation
5910	with provider associations, shall provide or cause the provision
5911	of a training program designed to inform facility operators on
5912	how to properly review bid documents relating to the
5913	installation of automatic fire sprinklers. The Office of the
5914	State Fire Marshal shall provide or cause the provision of this
5915	training within its existing budget, but may charge a fee for
5916	this training to offset its costs. The initial training must be
5917	delivered within 6 months after July 1, 1995, and as needed
5918	thereafter.
5919	d.  The administrator of a licensed facility shall sign an
5920	affidavit verifying the number of residents occupying the
5921	facility at the time of the evacuation capability evaluation.
5922	2.  Firesafety requirements.--
5923	a.  Except for the special applications provided herein,
5924	effective January 1, 1996, the provisions of the National Fire
5925	Protection Association, Life Safety Code, NFPA 101, 1994
5926	edition, Chapter 22 for new facilities and Chapter 23 for
5927	existing facilities shall be the uniform fire code applied by
5928	the State Fire Marshal for assisted living facilities, pursuant
5929	to s. 633.022.
5930	b.  Any new facility, regardless of size, that applies for
5931	a license on or after January 1, 1996, must be equipped with an
5932	automatic fire sprinkler system. The exceptions as provided in
5933	section 22-2.3.5.1, NFPA 101, 1994 edition, as adopted herein,
5934	apply to any new facility housing eight or fewer residents. On
5935	July 1, 1995, local governmental entities responsible for the
5936	issuance of permits for construction shall inform, without
5937	liability, any facility whose permit for construction is
5938	obtained prior to January 1, 1996, of this automatic fire
5939	sprinkler requirement. As used in this part, the term "a new
5940	facility" does not mean an existing facility that has undergone
5941	change of ownership.
5942	c.  Notwithstanding any provision of s. 633.022 or of the
5943	National Fire Protection Association, NFPA 101A, Chapter 5, 1995
5944	edition, to the contrary, any existing facility housing eight or
5945	fewer residents is not required to install an automatic fire
5946	sprinkler system, nor to comply with any other requirement in
5947	Chapter 23, NFPA 101, 1994 edition, that exceeds the firesafety
5948	requirements of NFPA 101, 1988 edition, that applies to this
5949	size facility, unless the facility has been classified as
5950	impractical to evacuate. Any existing facility housing eight or
5951	fewer residents that is classified as impractical to evacuate
5952	must install an automatic fire sprinkler system within the
5953	timeframes granted in this section.
5954	d.  Any existing facility that is required to install an
5955	automatic fire sprinkler system under this paragraph need not
5956	meet other firesafety requirements of Chapter 23, NFPA 101, 1994
5957	edition, which exceed the provisions of NFPA 101, 1988 edition.
5958	The mandate contained in this paragraph which requires certain
5959	facilities to install an automatic fire sprinkler system
5960	supersedes any other requirement.
5961	e.  This paragraph does not supersede the exceptions
5962	granted in NFPA 101, 1988 edition or 1994 edition.
5963	f.  This paragraph does not exempt facilities from other
5964	firesafety provisions adopted under s. 633.022 and local
5965	building code requirements in effect before July 1, 1995.
5966	g.  A local government may charge fees only in an amount
5967	not to exceed the actual expenses incurred by local government
5968	relating to the installation and maintenance of an automatic
5969	fire sprinkler system in an existing and properly licensed
5970	assisted living facility structure as of January 1, 1996.
5971	h.  If a licensed facility undergoes major reconstruction
5972	or addition to an existing building on or after January 1, 1996,
5973	the entire building must be equipped with an automatic fire
5974	sprinkler system. Major reconstruction of a building means
5975	repair or restoration that costs in excess of 50 percent of the
5976	value of the building as reported on the tax rolls, excluding
5977	land, before reconstruction. Multiple reconstruction projects
5978	within a 5-year period the total costs of which exceed 50
5979	percent of the initial value of the building at the time the
5980	first reconstruction project was permitted are to be considered
5981	as major reconstruction. Application for a permit for an
5982	automatic fire sprinkler system is required upon application for
5983	a permit for a reconstruction project that creates costs that go
5984	over the 50-percent threshold.
5985	i.  Any facility licensed before January 1, 1996, that is
5986	required to install an automatic fire sprinkler system shall
5987	ensure that the installation is completed within the following
5988	timeframes based upon evacuation capability of the facility as
5989	determined under subparagraph 1.:
5990	(I)  Impractical evacuation capability, 24 months.
5991	(II)  Slow evacuation capability, 48 months.
5992	(III)  Prompt evacuation capability, 60 months.
5993
5994	The beginning date from which the deadline for the automatic
5995	fire sprinkler installation requirement must be calculated is
5996	upon receipt of written notice from the local fire official that
5997	an automatic fire sprinkler system must be installed. The local
5998	fire official shall send a copy of the document indicating the
5999	requirement of a fire sprinkler system to the Agency for Health
6000	Care Administration.
6001	j.  It is recognized that the installation of an automatic
6002	fire sprinkler system may create financial hardship for some
6003	facilities. The appropriate local fire official shall, without
6004	liability, grant two 1-year extensions to the timeframes for
6005	installation established herein, if an automatic fire sprinkler
6006	installation cost estimate and proof of denial from two
6007	financial institutions for a construction loan to install the
6008	automatic fire sprinkler system are submitted. However, for any
6009	facility with a class I or class II, or a history of uncorrected
6010	class III, firesafety deficiencies, an extension must not be
6011	granted. The local fire official shall send a copy of the
6012	document granting the time extension to the Agency for Health
6013	Care Administration.
6014	k.  A facility owner whose facility is required to be
6015	equipped with an automatic fire sprinkler system under Chapter
6016	23, NFPA 101, 1994 edition, as adopted herein, must disclose to
6017	any potential buyer of the facility that an installation of an
6018	automatic fire sprinkler requirement exists. The sale of the
6019	facility does not alter the timeframe for the installation of
6020	the automatic fire sprinkler system.
6021	l.  Existing facilities required to install an automatic
6022	fire sprinkler system as a result of construction-type
6023	restrictions in Chapter 23, NFPA 101, 1994 edition, as adopted
6024	herein, or evacuation capability requirements shall be notified
6025	by the local fire official in writing of the automatic fire
6026	sprinkler requirement, as well as the appropriate date for final
6027	compliance as provided in this subparagraph. The local fire
6028	official shall send a copy of the document to the Agency for
6029	Health Care Administration.
6030	m.  Except in cases of life-threatening fire hazards, if an
6031	existing facility experiences a change in the evacuation
6032	capability, or if the local authority having jurisdiction
6033	identifies a construction-type restriction, such that an
6034	automatic fire sprinkler system is required, it shall be
6035	afforded time for installation as provided in this subparagraph.
6036
6037	Facilities that are fully sprinkled and in compliance with other
6038	firesafety standards are not required to conduct more than one
6039	of the required fire drills between the hours of 11 p.m. and 7
6040	a.m., per year. In lieu of the remaining drills, staff
6041	responsible for residents during such hours may be required to
6042	participate in a mock drill that includes a review of evacuation
6043	procedures. Such standards must be included or referenced in the
6044	rules adopted by the State Fire Marshal. Pursuant to s.
6045	633.022(1)(b), the State Fire Marshal is the final
6046	administrative authority for firesafety standards established
6047	and enforced pursuant to this section. All licensed facilities
6048	must have an annual fire inspection conducted by the local fire
6049	marshal or authority having jurisdiction.
6050	3.  Resident elopement requirements.--Facilities are
6051	required to conduct a minimum of two resident elopement
6052	prevention and response drills per year. All administrators and
6053	direct care staff must participate in the drills which shall
6054	include a review of procedures to address resident elopement.
6055	Facilities must document the implementation of the drills and
6056	ensure that the drills are conducted in a manner consistent with
6057	the facility's resident elopement policies and procedures.
6058	(b)  The preparation and annual update of a comprehensive
6059	emergency management plan. Such standards must be included in
6060	the rules adopted by the agency department after consultation
6061	with the Department of Community Affairs. At a minimum, the
6062	rules must provide for plan components that address emergency
6063	evacuation transportation; adequate sheltering arrangements;
6064	postdisaster activities, including provision of emergency power,
6065	food, and water; postdisaster transportation; supplies;
6066	staffing; emergency equipment; individual identification of
6067	residents and transfer of records; communication with families;
6068	and responses to family inquiries. The comprehensive emergency
6069	management plan is subject to review and approval by the local
6070	emergency management agency. During its review, the local
6071	emergency management agency shall ensure that the following
6072	agencies, at a minimum, are given the opportunity to review the
6073	plan: the Department of Elderly Affairs, the Department of
6074	Health, the Agency for Health Care Administration, and the
6075	Department of Community Affairs. Also, appropriate volunteer
6076	organizations must be given the opportunity to review the plan.
6077	The local emergency management agency shall complete its review
6078	within 60 days and either approve the plan or advise the
6079	facility of necessary revisions.
6080	(c)  The number, training, and qualifications of all
6081	personnel having responsibility for the care of residents. The
6082	rules must require adequate staff to provide for the safety of
6083	all residents. Facilities licensed for 17 or more residents are
6084	required to maintain an alert staff for 24 hours per day.
6085	(d)  All sanitary conditions within the facility and its
6086	surroundings which will ensure the health and comfort of
6087	residents. The rules must clearly delineate the responsibilities
6088	of the agency's licensure and survey staff, the county health
6089	departments, and the local authority having jurisdiction over
6090	fire safety and ensure that inspections are not duplicative. The
6091	agency may collect fees for food service inspections conducted
6092	by the county health departments and transfer such fees to the
6093	Department of Health.
6094	(e)  License application and license renewal, transfer of
6095	ownership, Proper management of resident funds and personal
6096	property, surety bonds, resident contracts, refund policies,
6097	financial ability to operate, and facility and staff records.
6098	(f)  Inspections, complaint investigations, moratoriums,
6099	classification of deficiencies, levying and enforcement of
6100	penalties, and use of income from fees and fines.
6101	(g)  The enforcement of the resident bill of rights
6102	specified in s. 400.428.
6103	(h)  The care and maintenance of residents, which must
6104	include, but is not limited to:
6105	1.  The supervision of residents;
6106	2.  The provision of personal services;
6107	3.  The provision of, or arrangement for, social and
6108	leisure activities;
6109	4.  The arrangement for appointments and transportation to
6110	appropriate medical, dental, nursing, or mental health services,
6111	as needed by residents;
6112	5.  The management of medication;
6113	6.  The nutritional needs of residents;
6114	7.  Resident records; and
6115	8.  Internal risk management and quality assurance.
6116	(i)  Facilities holding a limited nursing, extended
6117	congregate care, or limited mental health license.
6118	(j)  The establishment of specific criteria to define
6119	appropriateness of resident admission and continued residency in
6120	a facility holding a standard, limited nursing, extended
6121	congregate care, and limited mental health license.
6122	(k)  The use of physical or chemical restraints. The use of
6123	physical restraints is limited to half-bed rails as prescribed
6124	and documented by the resident's physician with the consent of
6125	the resident or, if applicable, the resident's representative or
6126	designee or the resident's surrogate, guardian, or attorney in
6127	fact. The use of chemical restraints is limited to prescribed
6128	dosages of medications authorized by the resident's physician
6129	and must be consistent with the resident's diagnosis. Residents
6130	who are receiving medications that can serve as chemical
6131	restraints must be evaluated by their physician at least
6132	annually to assess:
6133	1.  The continued need for the medication.
6134	2.  The level of the medication in the resident's blood.
6135	3.  The need for adjustments in the prescription.
6136	(l)  The establishment of specific policies and procedures
6137	on resident elopement. Facilities shall conduct a minimum of two
6138	resident elopement drills each year. All administrators and
6139	direct care staff shall participate in the drills. Facilities
6140	shall document the drills.
6141	(2)  In adopting any rules pursuant to this part, the
6142	agency department, in conjunction with the department agency,
6143	shall make distinct standards for facilities based upon facility
6144	size; the types of care provided; the physical and mental
6145	capabilities and needs of residents; the type, frequency, and
6146	amount of services and care offered; and the staffing
6147	characteristics of the facility. Rules developed pursuant to
6148	this section shall not restrict the use of shared staffing and
6149	shared programming in facilities that are part of retirement
6150	communities that provide multiple levels of care and otherwise
6151	meet the requirements of law and rule. Except for uniform
6152	firesafety standards, the agency department shall adopt by rule
6153	separate and distinct standards for facilities with 16 or fewer
6154	beds and for facilities with 17 or more beds. The standards for
6155	facilities with 16 or fewer beds shall be appropriate for a
6156	noninstitutional residential environment, provided that the
6157	structure is no more than two stories in height and all persons
6158	who cannot exit the facility unassisted in an emergency reside
6159	on the first floor. The agency department, in conjunction with
6160	the department agency, may make other distinctions among types
6161	of facilities as necessary to enforce the provisions of this
6162	part. Where appropriate, the agency shall offer alternate
6163	solutions for complying with established standards, based on
6164	distinctions made by the department and the agency relative to
6165	the physical characteristics of facilities and the types of care
6166	offered therein.
6167	(3)  The department shall submit a copy of proposed rules
6168	to the Speaker of the House of Representatives, the President of
6169	the Senate, and appropriate committees of substance for review
6170	and comment prior to the promulgation thereof.
6171	(a)  Rules adopted promulgated by the agency department
6172	shall encourage the development of homelike facilities which
6173	promote the dignity, individuality, personal strengths, and
6174	decisionmaking ability of residents.
6175	(4)(b)  The agency, in consultation with the department,
6176	may waive rules promulgated pursuant to this part in order to
6177	demonstrate and evaluate innovative or cost-effective congregate
6178	care alternatives which enable individuals to age in place. Such
6179	waivers may be granted only in instances where there is
6180	reasonable assurance that the health, safety, or welfare of
6181	residents will not be endangered. To apply for a waiver, the
6182	licensee shall submit to the agency a written description of the
6183	concept to be demonstrated, including goals, objectives, and
6184	anticipated benefits; the number and types of residents who will
6185	be affected, if applicable; a brief description of how the
6186	demonstration will be evaluated; and any other information
6187	deemed appropriate by the agency. Any facility granted a waiver
6188	shall submit a report of findings to the agency and the
6189	department within 12 months. At such time, the agency may renew
6190	or revoke the waiver or pursue any regulatory or statutory
6191	changes necessary to allow other facilities to adopt the same
6192	practices. The agency department may by rule clarify terms and
6193	establish waiver application procedures, criteria for reviewing
6194	waiver proposals, and procedures for reporting findings, as
6195	necessary to implement this subsection.
6196	(5)(4)  The agency may use an abbreviated biennial standard
6197	licensure inspection that consists of a review of key quality-
6198	of-care standards in lieu of a full inspection in facilities
6199	which have a good record of past performance. However, a full
6200	inspection shall be conducted in facilities which have had a
6201	history of class I or class II violations, uncorrected class III
6202	violations, confirmed ombudsman council complaints, or confirmed
6203	licensure complaints, within the previous licensure period
6204	immediately preceding the inspection or when a potentially
6205	serious problem is identified during the abbreviated inspection.
6206	The agency, in consultation with the department, shall develop
6207	the key quality-of-care standards with input from the State
6208	Long-Term Care Ombudsman Council and representatives of provider
6209	groups for incorporation into its rules. The department, in
6210	consultation with the agency, shall report annually to the
6211	Legislature concerning its implementation of this subsection.
6212	The report shall include, at a minimum, the key quality-of-care
6213	standards which have been developed; the number of facilities
6214	identified as being eligible for the abbreviated inspection; the
6215	number of facilities which have received the abbreviated
6216	inspection and, of those, the number that were converted to full
6217	inspection; the number and type of subsequent complaints
6218	received by the agency or department on facilities which have
6219	had abbreviated inspections; any recommendations for
6220	modification to this subsection; any plans by the agency to
6221	modify its implementation of this subsection; and any other
6222	information which the department believes should be reported.
6223	(5)  A fee shall be charged by the department to any person
6224	requesting a copy of this part or rules promulgated under this
6225	part. Such fees shall not exceed the actual cost of duplication
6226	and postage.
6227	Section 111.  Subsection (4) of section 400.442, Florida
6228	Statutes, is amended to read:
6229	400.442  Pharmacy and dietary services.--
6230	(4)  The agency department may by rule establish procedures
6231	and specify documentation as necessary to implement this
6232	section.
6233	Section 112.  Subsection (3) of section 400.444, Florida
6234	Statutes, is amended to read:
6235	400.444  Construction and renovation; requirements.--
6236	(3)  The agency department may adopt rules to establish
6237	procedures and specify the documentation necessary to implement
6238	this section.
6239	Section 113.  Subsections (4) through (7) of section
6240	400.447, Florida Statutes, are renumbered as subsections (1)
6241	through (4) and present subsections (1), (2), and (3) of said
6242	section are amended to read:
6243	400.447  Prohibited acts; penalties for violation.--
6244	(1)  It is unlawful for any person or public body to offer
6245	or advertise to the public, in any way by any medium whatever,
6246	personal services as defined in this act, without obtaining a
6247	valid current license. It is unlawful for any holder of a
6248	license issued pursuant to the provisions of this act to
6249	advertise or hold out to the public that it holds a license for
6250	a facility other than that for which it actually holds a
6251	license.
6252	(2)  It is unlawful for any holder of a license issued
6253	pursuant to the provisions of this act to withhold from the
6254	agency any evidence of financial instability, including, but not
6255	limited to, bad checks, delinquent accounts, nonpayment of
6256	withholding taxes, unpaid utility expenses, nonpayment for
6257	essential services, or adverse court action concerning the
6258	financial viability of the facility or any other facility
6259	licensed under part II or part III of this chapter which is
6260	owned by the licensee.
6261	(3)  Any person found guilty of violating subsection (1) or
6262	subsection (2) commits a misdemeanor of the second degree,
6263	punishable as provided in s. 775.083. Each day of continuing
6264	violation shall be considered a separate offense.
6265	Section 114.  Section 400.451, Florida Statutes, is
6266	repealed.
6267	Section 115.  Subsections (1), (3), and (6) of section
6268	400.452, Florida Statutes, as amended by section 3 of chapter
6269	2003-405, Laws of Florida, are amended to read:
6270	400.452  Staff training and educational programs; core
6271	educational requirement.--
6272	(1)  Administrators and other assisted living facility
6273	staff must meet minimum training and education requirements
6274	established by the Department of Elderly Affairs or agency by
6275	rule. This training and education is intended to assist
6276	facilities to appropriately respond to the needs of residents,
6277	to maintain resident care and facility standards, and to meet
6278	licensure requirements.
6279	(3)  Effective January 1, 2004, a new facility
6280	administrator must complete the required training and education,
6281	including the competency test, within a reasonable time after
6282	being employed as an administrator, as determined by the
6283	department. Failure to do so is a violation of this part and
6284	subjects the violator to an administrative fine as prescribed in
6285	s. 400.419. Administrators licensed in accordance with chapter
6286	468, part II, are exempt from this requirement. Other licensed
6287	professionals may be exempted, as determined by the department
6288	by rule.
6289	(6)  Other facility staff shall participate in training
6290	relevant to their job duties as specified by rule of the
6291	department.
6292	Section 116.  Section 400.454, Florida Statutes, is amended
6293	to read:
6294	400.454  Collection of information; local subsidy.--
6295	(1)  To enable the agency department to collect the
6296	information requested by the Legislature regarding the actual
6297	cost of providing room, board, and personal care in facilities,
6298	the agency may department is authorized to conduct field visits
6299	and audits of facilities as may be necessary. The owners of
6300	randomly sampled facilities shall submit such reports, audits,
6301	and accountings of cost as required the department may require
6302	by rule; provided that such reports, audits, and accountings
6303	shall be the minimum necessary to implement the provisions of
6304	this section. Any facility selected to participate in the study
6305	shall cooperate with the agency department by providing cost of
6306	operation information to interviewers.
6307	(2)  Local governments or organizations may contribute to
6308	the cost of care of local facility residents by further
6309	subsidizing the rate of state-authorized payment to such
6310	facilities. Implementation of local subsidy shall require agency
6311	departmental approval and shall not result in reductions in the
6312	state supplement.
6313	Section 117.  Subsections (1) and (4) of section 400.464,
6314	Florida Statutes, are amended to read:
6315	400.464  Home health agencies to be licensed; expiration of
6316	license; exemptions; unlawful acts; penalties.--
6317	(1)  The requirements of part II of chapter 408 shall apply
6318	to the provision of services that require licensure pursuant to
6319	this part and part II of chapter 408 and entities licensed or
6320	registered by or applying for such licensure or registration
6321	from the Agency for Health Care Administration pursuant to this
6322	part. However, each applicant for licensure and each licensee is
6323	exempt from the provisions of ss. 408.806(1)(e)2. and
6324	408.810(10). Any home health agency must be licensed by the
6325	agency to operate in this state. A license issued to a home
6326	health agency, unless sooner suspended or revoked, expires 1
6327	year after its date of issuance.
6328	(4)(a)  An organization may not provide, offer, or
6329	advertise home health services to the public unless the
6330	organization has a valid license or is specifically exempted
6331	under this part. An organization that offers or advertises to
6332	the public any service for which licensure or registration is
6333	required under this part must include in the advertisement the
6334	license number or regulation number issued to the organization
6335	by the agency. The agency shall assess a fine of not less than
6336	$100 to any licensee or registrant who fails to include the
6337	license or registration number when submitting the advertisement
6338	for publication, broadcast, or printing. The holder of a license
6339	issued under this part may not advertise or indicate to the
6340	public that it holds a home health agency or nurse registry
6341	license other than the one it has been issued.
6342	(b)  A person who violates paragraph (a) is subject to an
6343	injunctive proceeding under s. 408.816 400.515. A violation of
6344	paragraph (a) or s. 408.813 is a deceptive and unfair trade
6345	practice and constitutes a violation of the Florida Deceptive
6346	and Unfair Trade Practices Act.
6347	(c)  A person who violates the provisions of paragraph (a)
6348	commits a misdemeanor of the second degree, punishable as
6349	provided in s. 775.082 or s. 775.083. Any person who commits a
6350	second or subsequent violation commits a misdemeanor of the
6351	first degree, punishable as provided in s. 775.082 or s.
6352	775.083. Each day of continuing violation constitutes a separate
6353	offense.
6354	Section 118.  Section 400.471, Florida Statutes, is amended
6355	to read:
6356	400.471  Application for license; fee; provisional license;
6357	temporary permit.--
6358	(1)  Each applicant for licensure must comply with all
6359	provisions of this part and part II of chapter 408. Application
6360	for an initial license or for renewal of an existing license
6361	must be made under oath to the agency on forms furnished by it
6362	and must be accompanied by the appropriate license fee as
6363	provided in subsection (8). The agency must take final action on
6364	an initial licensure application within 60 days after receipt of
6365	all required documentation.
6366	(2)  In addition to the requirements of part II of chapter
6367	408, the applicant must file with the application satisfactory
6368	proof that the home health agency is in compliance with this
6369	part and applicable rules, including:
6370	(a)  A listing of services to be provided, either directly
6371	by the applicant or through contractual arrangements with
6372	existing providers.;
6373	(b)  The number and discipline of professional staff to be
6374	employed.; and
6375	(c)  Proof of financial ability to operate.
6376	(3)  An applicant for initial licensure must demonstrate
6377	financial ability to operate by submitting a balance sheet and
6378	income and expense statement for the first 2 years of operation
6379	which provide evidence of having sufficient assets, credit, and
6380	projected revenues to cover liabilities and expenses. The
6381	applicant shall have demonstrated financial ability to operate
6382	if the applicant's assets, credit, and projected revenues meet
6383	or exceed projected liabilities and expenses. All documents
6384	required under this subsection must be prepared in accordance
6385	with generally accepted accounting principles, and the financial
6386	statement must be signed by a certified public accountant.
6387	(4)  Each applicant for licensure must comply with the
6388	following requirements:
6389	(a)  Upon receipt of a completed, signed, and dated
6390	application, the agency shall require background screening of
6391	the applicant, in accordance with the level 2 standards for
6392	screening set forth in chapter 435. As used in this subsection,
6393	the term "applicant" means the administrator, or a similarly
6394	titled person who is responsible for the day-to-day operation of
6395	the licensed home health agency, and the financial officer, or
6396	similarly titled individual who is responsible for the financial
6397	operation of the licensed home health agency.
6398	(b)  The agency may require background screening for a
6399	member of the board of directors of the licensee or an officer
6400	or an individual owning 5 percent or more of the licensee if the
6401	agency reasonably suspects that such individual has been
6402	convicted of an offense prohibited under the level 2 standards
6403	for screening set forth in chapter 435.
6404	(c)  Proof of compliance with the level 2 background
6405	screening requirements of chapter 435 which has been submitted
6406	within the previous 5 years in compliance with any other health
6407	care or assisted living licensure requirements of this state is
6408	acceptable in fulfillment of paragraph (a). Proof of compliance
6409	with background screening which has been submitted within the
6410	previous 5 years to fulfill the requirements of the Financial
6411	Services Commission and the Office of Insurance Regulation
6412	pursuant to chapter 651 as part of an application for a
6413	certificate of authority to operate a continuing care retirement
6414	community is acceptable in fulfillment of the Department of Law
6415	Enforcement and Federal Bureau of Investigation background
6416	check.
6417	(d)  A provisional license may be granted to an applicant
6418	when each individual required by this section to undergo
6419	background screening has met the standards for the Department of
6420	Law Enforcement background check, but the agency has not yet
6421	received background screening results from the Federal Bureau of
6422	Investigation. A standard license may be granted to the licensee
6423	upon the agency's receipt of a report of the results of the
6424	Federal Bureau of Investigation background screening for each
6425	individual required by this section to undergo background
6426	screening which confirms that all standards have been met, or
6427	upon the granting of a disqualification exemption by the agency
6428	as set forth in chapter 435. Any other person who is required to
6429	undergo level 2 background screening may serve in his or her
6430	capacity pending the agency's receipt of the report from the
6431	Federal Bureau of Investigation. However, the person may not
6432	continue to serve if the report indicates any violation of
6433	background screening standards and a disqualification exemption
6434	has not been requested of and granted by the agency as set forth
6435	in chapter 435.
6436	(e)  Each applicant must submit to the agency, with its
6437	application, a description and explanation of any exclusions,
6438	permanent suspensions, or terminations of the licensee or
6439	potential licensee from the Medicare or Medicaid programs. Proof
6440	of compliance with the requirements for disclosure of ownership
6441	and control interest under the Medicaid or Medicare programs may
6442	be accepted in lieu of this submission.
6443	(f)  Each applicant must submit to the agency a description
6444	and explanation of any conviction of an offense prohibited under
6445	the level 2 standards of chapter 435 by a member of the board of
6446	directors of the applicant, its officers, or any individual
6447	owning 5 percent or more of the applicant. This requirement does
6448	not apply to a director of a not-for-profit corporation or
6449	organization if the director serves solely in a voluntary
6450	capacity for the corporation or organization, does not regularly
6451	take part in the day-to-day operational decisions of the
6452	corporation or organization, receives no remuneration for his or
6453	her services on the corporation or organization's board of
6454	directors, and has no financial interest and has no family
6455	members with a financial interest in the corporation or
6456	organization, provided that the director and the not-for-profit
6457	corporation or organization include in the application a
6458	statement affirming that the director's relationship to the
6459	corporation satisfies the requirements of this paragraph.
6460	(g)  A license may not be granted to an applicant if the
6461	applicant, administrator, or financial officer has been found
6462	guilty of, regardless of adjudication, or has entered a plea of
6463	nolo contendere or guilty to, any offense prohibited under the
6464	level 2 standards for screening set forth in chapter 435, unless
6465	an exemption from disqualification has been granted by the
6466	agency as set forth in chapter 435.
6467	(h)  The agency may deny or revoke licensure if the
6468	applicant:
6469	1.  Has falsely represented a material fact in the
6470	application required by paragraph (e) or paragraph (f), or has
6471	omitted any material fact from the application required by
6472	paragraph (e) or paragraph (f); or
6473	2.  Has been or is currently excluded, suspended,
6474	terminated from, or has involuntarily withdrawn from
6475	participation in this state's Medicaid program, or the Medicaid
6476	program of any other state, or from participation in the
6477	Medicare program or any other governmental or private health
6478	care or health insurance program.
6479	(i)  An application for license renewal must contain the
6480	information required under paragraphs (e) and (f).
6481	(3)(5)  In addition to the requirements of s. 408.810, the
6482	home health agency must also obtain and maintain the following
6483	insurance coverages in an amount of not less than $250,000 per
6484	claim, and the home health agency must submit proof of coverage
6485	with an initial application for licensure and with each annual
6486	application for license renewal:
6487	(a)  Malpractice insurance as defined in s. 624.605(1)(k).;
6488	(b)  Liability insurance as defined in s. 624.605(1)(b).
6489	(6)  Ninety days before the expiration date, an application
6490	for renewal must be submitted to the agency under oath on forms
6491	furnished by it, and a license must be renewed if the applicant
6492	has met the requirements established under this part and
6493	applicable rules. The home health agency must file with the
6494	application satisfactory proof that it is in compliance with
6495	this part and applicable rules. If there is evidence of
6496	financial instability, the home health agency must submit
6497	satisfactory proof of its financial ability to comply with the
6498	requirements of this part.
6499	(7)  When transferring the ownership of a home health
6500	agency, the transferee must submit an application for a license
6501	at least 60 days before the effective date of the transfer. If
6502	the home health agency is being leased, a copy of the lease
6503	agreement must be filed with the application.
6504	(4)(8)  In accordance with s. 408.805, an applicant or
6505	licensee shall pay a fee for each license application submitted
6506	under this part, part II of chapter 408, and applicable rules.
6507	The amount of the fee shall be established by rule and shall be
6508	set at The license fee and annual renewal fee required of a home
6509	health agency are nonrefundable. The agency shall set the fees
6510	in an amount that is sufficient to cover the agency's its costs
6511	in carrying out its responsibilities under this part, but not to
6512	exceed $2,000 per biennium $1,000. However, state, county, or
6513	municipal governments applying for licenses under this part are
6514	exempt from the payment of license fees. All fees collected
6515	under this part must be deposited in the Health Care Trust Fund
6516	for the administration of this part.
6517	(9)  The license must be displayed in a conspicuous place
6518	in the administrative office of the home health agency and is
6519	valid only while in the possession of the person to which it is
6520	issued. The license may not be sold, assigned, or otherwise
6521	transferred, voluntarily or involuntarily, and is valid only for
6522	the home health agency and location for which originally issued.
6523	(10)  A home health agency against whom a revocation or
6524	suspension proceeding is pending at the time of license renewal
6525	may be issued a provisional license effective until final
6526	disposition by the agency of such proceedings. If judicial
6527	relief is sought from the final disposition, the court that has
6528	jurisdiction may issue a temporary permit for the duration of
6529	the judicial proceeding.
6530	(5)(11)  The agency may not issue a license designated as
6531	certified to a home health agency that fails to satisfy the
6532	requirements of a Medicare certification survey from the agency.
6533	(12)  The agency may not issue a license to a home health
6534	agency that has any unpaid fines assessed under this part.
6535	Section 119.  Section 400.474, Florida Statutes, is amended
6536	to read:
6537	400.474  Denial, suspension, revocation of license;
6538	injunction; grounds; penalties.--
6539	(1)  The agency may deny, revoke, and or suspend a license,
6540	and or impose an administrative fine in the manner provided in
6541	chapter 120, or initiate injunctive proceedings under this part,
6542	part II of chapter 408, or applicable rules s. 400.515.
6543	(2)  Any of the following actions by a home health agency
6544	or its employee is grounds for disciplinary action by the
6545	agency:
6546	(a)  Violation of this part, part II of chapter 408, or of
6547	applicable rules.
6548	(b)  An intentional, reckless, or negligent act that
6549	materially affects the health or safety of a patient.
6550	(c)  Knowingly providing home health services in an
6551	unlicensed assisted living facility or unlicensed adult family-
6552	care home, unless the home health agency or employee reports the
6553	unlicensed facility or home to the agency within 72 hours after
6554	providing the services.
6555	(3)  The agency may impose the following penalties for
6556	operating without a license upon an applicant or owner who has
6557	in the past operated, or who currently operates, a licensed home
6558	health agency.
6559	(a)  If a home health agency that is found to be operating
6560	without a license wishes to apply for a license, the home health
6561	agency may submit an application only after the agency has
6562	verified that the home health agency no longer operates an
6563	unlicensed home health agency.
6564	(b)  Any person, partnership, or corporation that violates
6565	paragraph (a) and that previously operated a licensed home
6566	health agency or concurrently operates both a licensed home
6567	health agency and an unlicensed home health agency commits a
6568	felony of the third degree punishable as provided in s. 775.082,
6569	s. 775.083, or s. 775.084. If an owner has an interest in more
6570	than one home health agency and fails to license any one of
6571	those home health agencies, the agency must issue a cease and
6572	desist order for the activities of the unlicensed home health
6573	agency and impose a moratorium on any or all of the licensed
6574	related home health agencies until the unlicensed home health
6575	agency is licensed.
6576	(3)(c)  If any home health agency is found to be operating
6577	without a license meets the criteria in paragraph (a) or
6578	paragraph (b) and that home health agency has received any
6579	government reimbursement for services provided by an unlicensed
6580	home health agency, the agency shall make a fraud referral to
6581	the appropriate government reimbursement program.
6582	(4)  The agency may deny, revoke, or suspend the license of
6583	a home health agency, or may impose on a home health agency
6584	administrative fines not to exceed the aggregate sum of $5,000
6585	if:
6586	(a)  The agency is unable to obtain entry to the home
6587	health agency to conduct a licensure survey, complaint
6588	investigation, surveillance visit, or monitoring visit.
6589	(b)  An applicant or a licensed home health agency has
6590	falsely represented a material fact in the application, or has
6591	omitted from the application any material fact, including, but
6592	not limited to, the fact that the controlling or ownership
6593	interest is held by any officer, director, agent, manager,
6594	employee, affiliated person, partner, or shareholder who is not
6595	eligible to participate.
6596	(c)  An applicant, owner, or person who has a 5 percent or
6597	greater interest in a licensed entity:
6598	1.  Has been previously found by any licensing, certifying,
6599	or professional standards board or agency to have violated the
6600	standards or conditions that relate to home health-related
6601	licensure or certification, or to the quality of home health-
6602	related services provided; or
6603	2.  Has been or is currently excluded, suspended,
6604	terminated from, or has involuntarily withdrawn from,
6605	participation in the Medicaid program of this state or any other
6606	state, the Medicare program, or any other governmental health
6607	care or health insurance program.
6608	Section 120.  Subsection (1) and paragraphs (a) and (b) of
6609	subsection (2) of section 400.484, Florida Statutes, are amended
6610	to read:
6611	400.484  Right of inspection; deficiencies; fines.--
6612	(1)  In accordance with s. 408.811, Any duly authorized
6613	officer or employee of the agency may make such inspections and
6614	investigations as are necessary in order to determine the state
6615	of compliance with this part and with applicable rules. The
6616	right of inspection extends to any business that the agency has
6617	reason to believe is being operated as a home health agency
6618	without a license, but such inspection of any such business may
6619	not be made without the permission of the owner or person in
6620	charge unless a warrant is first obtained from a circuit court.
6621	Any application for a license issued under this part or for
6622	license renewal constitutes permission for an appropriate
6623	inspection to verify the information submitted on or in
6624	connection with the application.
6625	(2)  The agency shall impose fines for various classes of
6626	deficiencies in accordance with the following schedule:
6627	(a)  A class I deficiency is any act, omission, or practice
6628	that results in a patient's death, disablement, or permanent
6629	injury, or places a patient at imminent risk of death,
6630	disablement, or permanent injury. Upon finding a class I
6631	deficiency, the agency may impose an administrative fine in the
6632	amount of $5,000 for each occurrence and each day that the
6633	deficiency exists. In addition, the agency may immediately
6634	revoke the license and, or impose a moratorium pursuant to part
6635	II of chapter 408 on the admission of new patients, until the
6636	factors causing the deficiency have been corrected.
6637	(b)  A class II deficiency is any act, omission, or
6638	practice that has a direct adverse effect on the health, safety,
6639	or security of a patient. Upon finding a class II deficiency,
6640	the agency may impose an administrative fine in the amount of
6641	$1,000 for each occurrence and each day that the deficiency
6642	exists. In addition, the agency may suspend the license and, or
6643	impose a moratorium pursuant to part II of chapter 408 on the
6644	admission of new patients, until the deficiency has been
6645	corrected.
6646	Section 121.  Subsections (1) and (2) of section 400.487,
6647	Florida Statutes, are amended to read:
6648	400.487  Home health service agreements; physician's,
6649	physician assistant's, and advanced registered nurse
6650	practitioner's treatment orders; patient assessment;
6651	establishment and review of plan of care; provision of services;
6652	orders not to resuscitate.--
6653	(1)  Services provided by a home health agency must be
6654	covered by an agreement between the home health agency and the
6655	patient or the patient's legal representative specifying the
6656	home health services to be provided, the rates or charges for
6657	services paid with private funds, and the sources method of
6658	payment, which may include Medicare, Medicaid, private
6659	insurance, personal funds, or a combination thereof. A home
6660	health agency providing skilled care must make an assessment of
6661	the patient's needs within 48 hours after the start of services.
6662	(2)  When required by the provisions of chapter 464; part
6663	I, part III, or part V of chapter 468; or chapter 486, the
6664	attending physician, physician assistant, or advanced registered
6665	nurse practitioner, acting within his or her respective scope of
6666	practice, shall for a patient who is to receive skilled care
6667	must establish treatment orders for a patient who is to receive
6668	skilled care. The treatment orders must be signed by the
6669	physician, physician assistant, or advanced registered nurse
6670	practitioner before a claim is submitted to a managed care
6671	organization and the treatment orders must be signed in the time
6672	allowed under the provider agreement. The treatment orders shall
6673	within 30 days after the start of care and must be reviewed, as
6674	frequently as the patient's illness requires, by the physician,
6675	physician assistant, or advanced registered nurse practitioner,
6676	in consultation with the home health agency personnel that
6677	provide services to the patient.
6678	Section 122.  Section 400.494, Florida Statutes, is amended
6679	to read:
6680	400.494  Information about patients confidential.--
6681	(1)  Information about patients received by persons
6682	employed by, or providing services to, a home health agency or
6683	received by the licensing agency through reports or inspection
6684	shall be confidential and exempt from the provisions of s.
6685	119.07(1) and shall not be disclosed to any person other than
6686	the patient without the written consent of that patient or the
6687	patient's guardian.
6688	(2)  This section does not apply to information lawfully
6689	requested by the Medicaid Fraud Control Unit of the Office of
6690	the Attorney General or requested pursuant to 408.811 Department
6691	of Legal Affairs.
6692	Section 123.  Section 400.495, Florida Statutes, is amended
6693	to read:
6694	400.495  Notice of toll-free telephone number for central
6695	abuse hotline.--In addition to the requirements of 408.810(5),
6696	On or before the first day home health services are provided to
6697	a patient, any home health agency or nurse registry licensed
6698	under this part must inform the patient and his or her immediate
6699	family, if appropriate, of the right to report abusive,
6700	neglectful, or exploitative practices. The statewide toll-free
6701	telephone number for the central abuse hotline must be provided
6702	to patients in a manner that is clearly legible and must include
6703	the words: "To report abuse, neglect, or exploitation, please
6704	call toll-free   (phone number)  ." the Agency for Health Care
6705	Administration shall adopt rules that provide for 90 days'
6706	advance notice of a change in the toll-free telephone number and
6707	that outline due process procedures, as provided under chapter
6708	120, for home health agency personnel and nurse registry
6709	personnel who are reported to the central abuse hotline. Home
6710	health agencies and nurse registries shall establish appropriate
6711	policies and procedures for providing such notice to patients.
6712	Section 124.  Section 400.497, Florida Statutes, is amended
6713	to read:
6714	400.497  Rules establishing minimum standards.--The agency
6715	shall adopt, publish, and enforce rules to implement part II of
6716	chapter 408 and this part, including, as applicable, ss. 400.506
6717	and 400.509, which must provide reasonable and fair minimum
6718	standards relating to:
6719	(1)  The home health aide competency test and home health
6720	aide training. The agency shall create the home health aide
6721	competency test and establish the curriculum and instructor
6722	qualifications for home health aide training. Licensed home
6723	health agencies may provide this training and shall furnish
6724	documentation of such training to other licensed home health
6725	agencies upon request. Successful passage of the competency test
6726	by home health aides may be substituted for the training
6727	required under this section and any rule adopted pursuant
6728	thereto.
6729	(2)  Shared staffing. The agency shall allow shared
6730	staffing if the home health agency is part of a retirement
6731	community that provides multiple levels of care, is located on
6732	one campus, is licensed under this chapter, and otherwise meets
6733	the requirements of law and rule.
6734	(3)  The criteria for the frequency of onsite licensure
6735	surveys.
6736	(4)  Licensure application and renewal.
6737	(5)  The requirements for onsite and electronic
6738	accessibility of supervisory personnel of home health agencies.
6739	(6)  Information to be included in patients' records.
6740	(7)  Geographic service areas.
6741	(8)  Preparation of a comprehensive emergency management
6742	plan pursuant to s. 400.492.
6743	(a)  The Agency for Health Care Administration shall adopt
6744	rules establishing minimum criteria for the plan and plan
6745	updates, with the concurrence of the Department of Health and in
6746	consultation with the Department of Community Affairs.
6747	(b)  The rules must address the requirements in s. 400.492.
6748	In addition, the rules shall provide for the maintenance of
6749	patient-specific medication lists that can accompany patients
6750	who are transported from their homes.
6751	(c)  The plan is subject to review and approval by the
6752	county health department. During its review, the county health
6753	department shall ensure that the following agencies, at a
6754	minimum, are given the opportunity to review the plan:
6755	1.  The local emergency management agency.
6756	2.  The Agency for Health Care Administration.
6757	3.  The local chapter of the American Red Cross or other
6758	lead sheltering agency.
6759	4.  The district office of the Department of Children and
6760	Family Services.
6761
6762	The county health department shall complete its review within 60
6763	days after receipt of the plan and shall either approve the plan
6764	or advise the home health agency of necessary revisions.
6765	(d)  For any home health agency that operates in more than
6766	one county, the Department of Health shall review the plan,
6767	after consulting with all of the county health departments, the
6768	agency, and all the local chapters of the American Red Cross or
6769	other lead sheltering agencies in the areas of operation for
6770	that particular home health agency. The Department of Health
6771	shall complete its review within 90 days after receipt of the
6772	plan and shall either approve the plan or advise the home health
6773	agency of necessary revisions. The Department of Health shall
6774	make every effort to avoid imposing differing requirements based
6775	on differences between counties on the home health agency.
6776	(e)  The requirements in this subsection do not apply to:
6777	1.  A facility that is certified under chapter 651 and has
6778	a licensed home health agency used exclusively by residents of
6779	the facility; or
6780	2.  A retirement community that consists of residential
6781	units for independent living and either a licensed nursing home
6782	or an assisted living facility, and has a licensed home health
6783	agency used exclusively by the residents of the retirement
6784	community, provided the comprehensive emergency management plan
6785	for the facility or retirement community provides for continuous
6786	care of all residents with special needs during an emergency.
6787	Section 125.  Section 400.506, Florida Statutes, is amended
6788	to read:
6789	400.506  Licensure of nurse registries; requirements;
6790	penalties.--
6791	(1)  A nurse registry is exempt from the licensing
6792	requirements of a home health agency but must be licensed as a
6793	nurse registry. The requirements of part II of chapter 408 shall
6794	apply to the provision of services that require licensure
6795	pursuant to ss. 400.506-400.518 and part II of chapter 408 and
6796	to entities licensed by or applying for such license from the
6797	Agency for Health Care Administration pursuant to ss. 400.506-
6798	400.518. Each operational site of the nurse registry must be
6799	licensed, unless there is more than one site within a county. If
6800	there is more than one site within a county, only one license
6801	per county is required. Each operational site must be listed on
6802	the license.
6803	(2)  Each applicant for licensure and each licensee must
6804	comply with all provisions of part II and chapter 408, except
6805	ss. 408.806(1)(e)2., 408.810(6), and 408.810(10). the following
6806	requirements:
6807	(a)  Upon receipt of a completed, signed, and dated
6808	application, the agency shall require background screening, in
6809	accordance with the level 2 standards for screening set forth in
6810	chapter 435, of the managing employee, or other similarly titled
6811	individual who is responsible for the daily operation of the
6812	nurse registry, and of the financial officer, or other similarly
6813	titled individual who is responsible for the financial operation
6814	of the registry, including billings for patient care and
6815	services. The applicant shall comply with the procedures for
6816	level 2 background screening as set forth in chapter 435.
6817	(b)  The agency may require background screening of any
6818	other individual who is an applicant if the agency has probable
6819	cause to believe that he or she has been convicted of a crime or
6820	has committed any other offense prohibited under the level 2
6821	standards for screening set forth in chapter 435.
6822	(c)  Proof of compliance with the level 2 background
6823	screening requirements of chapter 435 which has been submitted
6824	within the previous 5 years in compliance with any other health
6825	care or assisted living licensure requirements of this state is
6826	acceptable in fulfillment of the requirements of paragraph (a).
6827	(d)  A provisional license may be granted to an applicant
6828	when each individual required by this section to undergo
6829	background screening has met the standards for the Department of
6830	Law Enforcement background check but the agency has not yet
6831	received background screening results from the Federal Bureau of
6832	Investigation. A standard license may be granted to the
6833	applicant upon the agency's receipt of a report of the results
6834	of the Federal Bureau of Investigation background screening for
6835	each individual required by this section to undergo background
6836	screening which confirms that all standards have been met, or
6837	upon the granting of a disqualification exemption by the agency
6838	as set forth in chapter 435. Any other person who is required to
6839	undergo level 2 background screening may serve in his or her
6840	capacity pending the agency's receipt of the report from the
6841	Federal Bureau of Investigation. However, the person may not
6842	continue to serve if the report indicates any violation of
6843	background screening standards and a disqualification exemption
6844	has not been requested of and granted by the agency as set forth
6845	in chapter 435.
6846	(e)  Each applicant must submit to the agency, with its
6847	application, a description and explanation of any exclusions,
6848	permanent suspensions, or terminations of the applicant from the
6849	Medicare or Medicaid programs. Proof of compliance with the
6850	requirements for disclosure of ownership and control interests
6851	under the Medicaid or Medicare programs may be accepted in lieu
6852	of this submission.
6853	(f)  Each applicant must submit to the agency a description
6854	and explanation of any conviction of an offense prohibited under
6855	the level 2 standards of chapter 435 by a member of the board of
6856	directors of the applicant, its officers, or any individual
6857	owning 5 percent or more of the applicant. This requirement does
6858	not apply to a director of a not-for-profit corporation or
6859	organization if the director serves solely in a voluntary
6860	capacity for the corporation or organization, does not regularly
6861	take part in the day-to-day operational decisions of the
6862	corporation or organization, receives no remuneration for his or
6863	her services on the corporation or organization's board of
6864	directors, and has no financial interest and has no family
6865	members with a financial interest in the corporation or
6866	organization, provided that the director and the not-for-profit
6867	corporation or organization include in the application a
6868	statement affirming that the director's relationship to the
6869	corporation satisfies the requirements of this paragraph.
6870	(g)  A license may not be granted to an applicant if the
6871	applicant or managing employee has been found guilty of,
6872	regardless of adjudication, or has entered a plea of nolo
6873	contendere or guilty to, any offense prohibited under the level
6874	2 standards for screening set forth in chapter 435, unless an
6875	exemption from disqualification has been granted by the agency
6876	as set forth in chapter 435.
6877	(h)  The agency may deny or revoke the license if any
6878	applicant:
6879	1.  Has falsely represented a material fact in the
6880	application required by paragraph (e) or paragraph (f), or has
6881	omitted any material fact from the application required by
6882	paragraph (e) or paragraph (f); or
6883	2.  Has had prior action taken against the applicant under
6884	the Medicaid or Medicare program as set forth in paragraph (e).
6885	(i)  An application for license renewal must contain the
6886	information required under paragraphs (e) and (f).
6887	(3)  In accordance with s. 408.805, an applicant or
6888	licensee shall pay a fee for each license application submitted
6889	under ss. 400.508-400.518, part II of chapter 408, and
6890	applicable rules. The amount of the fee shall be established by
6891	rule and may not exceed $2,000 per biennium. Application for
6892	license must be made to the Agency for Health Care
6893	Administration on forms furnished by it and must be accompanied
6894	by the appropriate licensure fee, as established by rule and not
6895	to exceed the cost of regulation under this part. The licensure
6896	fee for nurse registries may not exceed $1,000 and must be
6897	deposited in the Health Care Trust Fund.
6898	(4)  The Agency for Health Care Administration may deny,
6899	revoke, or suspend a license or impose an administrative fine in
6900	the manner provided in chapter 120 against a nurse registry
6901	that:
6902	(a)  Fails to comply with this section or applicable rules.
6903	(b)  Commits an intentional, reckless, or negligent act
6904	that materially affects the health or safety of a person
6905	receiving services.
6906	(5)  A license issued for the operation of a nurse
6907	registry, unless sooner suspended or revoked, expires 1 year
6908	after its date of issuance. Sixty days before the expiration
6909	date, an application for renewal must be submitted to the Agency
6910	for Health Care Administration on forms furnished by it. The
6911	Agency for Health Care Administration shall renew the license if
6912	the applicant has met the requirements of this section and
6913	applicable rules. A nurse registry against which a revocation or
6914	suspension proceeding is pending at the time of license renewal
6915	may be issued a conditional license effective until final
6916	disposition by the Agency for Health Care Administration of such
6917	proceedings. If judicial relief is sought from the final
6918	disposition, the court having jurisdiction may issue a
6919	conditional license for the duration of the judicial proceeding.
6920	(6)  The Agency for Health Care Administration may
6921	institute injunctive proceedings under s. 400.515.
6922	(4)(7)  A person that offers or advertises to the public
6923	that it provides any service for which licensure is required
6924	under this section must include in such advertisement the
6925	license number issued to it by the Agency for Health Care
6926	Administration.
6927	(8)  It is unlawful for a person to offer or advertise to
6928	the public services as defined by rule without obtaining a valid
6929	license from the Agency for Health Care Administration. It is
6930	unlawful for any holder of a license to advertise or hold out to
6931	the public that he or she holds a license for other than that
6932	for which he or she actually holds a license. A person who
6933	violates this subsection is subject to injunctive proceedings
6934	under s. 400.515.
6935	(9)  Any duly authorized officer or employee of the Agency
6936	for Health Care Administration may make such inspections and
6937	investigations as are necessary to respond to complaints or to
6938	determine the state of compliance with this section and
6939	applicable rules.
6940	(a)  If, in responding to a complaint, an agent or employee
6941	of the Agency for Health Care Administration has reason to
6942	believe that a crime has been committed, he or she shall notify
6943	the appropriate law enforcement agency.
6944	(b)  If, in responding to a complaint, an agent or employee
6945	of the Agency for Health Care Administration has reason to
6946	believe that abuse, neglect, or exploitation has occurred,
6947	according to the definitions in chapter 415, he or she shall
6948	file a report under chapter 415.
6949	(5)(10)(a)  A nurse registry may refer for contract in
6950	private residences registered nurses and licensed practical
6951	nurses registered and licensed under part I of chapter 464,
6952	certified nursing assistants certified under part II of chapter
6953	464, home health aides who present documented proof of
6954	successful completion of the training required by rule of the
6955	agency, and companions or homemakers for the purposes of
6956	providing those services authorized under s. 400.509(1). Each
6957	person referred by a nurse registry must provide current
6958	documentation that he or she is free from communicable diseases.
6959	(b)  A certified nursing assistant or home health aide may
6960	be referred for a contract to provide care to a patient in his
6961	or her home only if that patient is under a physician's care. A
6962	certified nursing assistant or home health aide referred for
6963	contract in a private residence shall be limited to assisting a
6964	patient with bathing, dressing, toileting, grooming, eating,
6965	physical transfer, and those normal daily routines the patient
6966	could perform for himself or herself were he or she physically
6967	capable. A certified nursing assistant or home health aide may
6968	not provide medical or other health care services that require
6969	specialized training and that may be performed only by licensed
6970	health care professionals. The nurse registry shall obtain the
6971	name and address of the attending physician and send written
6972	notification to the physician within 48 hours after a contract
6973	is concluded that a certified nursing assistant or home health
6974	aide will be providing care for that patient.
6975	(c)  A nurse registry shall, at the time of contracting for
6976	services through the nurse registry, advise the patient, the
6977	patient's family, or a person acting on behalf of the patient of
6978	the availability of registered nurses to make visits to the
6979	patient's home at an additional cost. A registered nurse shall
6980	make monthly visits to the patient's home to assess the
6981	patient's condition and quality of care being provided by the
6982	certified nursing assistant or home health aide. Any condition
6983	that which in the professional judgment of the nurse requires
6984	further medical attention shall be reported to the attending
6985	physician and the nurse registry. The assessment shall become a
6986	part of the patient's file with the nurse registry and may be
6987	reviewed by the agency during their survey procedure.
6988	(6)(11)  A person who is referred by a nurse registry for
6989	contract in private residences and who is not a nurse licensed
6990	under part I of chapter 464 may perform only those services or
6991	care to clients that the person has been certified to perform or
6992	trained to perform as required by law or rules of the Agency for
6993	Health Care Administration or the Department of Business and
6994	Professional Regulation. Providing services beyond the scope
6995	authorized under this subsection constitutes the unauthorized
6996	practice of medicine or a violation of the Nurse Practice Act
6997	and is punishable as provided under chapter 458, chapter 459, or
6998	part I of chapter 464.
6999	(7)(12)  Each nurse registry must require every applicant
7000	for contract to complete an application form providing the
7001	following information:
7002	(a)  The name, address, date of birth, and social security
7003	number of the applicant.
7004	(b)  The educational background and employment history of
7005	the applicant.
7006	(c)  The number and date of the applicable license or
7007	certification.
7008	(d)  When appropriate, information concerning the renewal
7009	of the applicable license, registration, or certification.
7010	(8)(13)  Each nurse registry must comply with the
7011	procedures set forth in s. 400.512 for maintaining records of
7012	the employment history of all persons referred for contract and
7013	is subject to the standards and conditions set forth in that
7014	section. However, an initial screening may not be required for
7015	persons who have been continuously registered with the nurse
7016	registry since September 30, 1990.
7017	(9)(14)  The nurse registry must maintain the application
7018	on file, and that file must be open to the inspection of the
7019	Agency for Health Care Administration. The nurse registry must
7020	maintain on file the name and address of the client to whom the
7021	nurse or other nurse registry personnel is sent for contract and
7022	the amount of the fee received by the nurse registry. A nurse
7023	registry must maintain the file that includes the application
7024	and other applicable documentation for 3 years after the date of
7025	the last file entry of client-related information.
7026	(10)(15)  Nurse registries shall assist persons who would
7027	need assistance and sheltering during evacuations because of
7028	physical, mental, or sensory disabilities in registering with
7029	the appropriate local emergency management agency pursuant to s.
7030	252.355.
7031	(11)(16)  Each nurse registry shall prepare and maintain a
7032	comprehensive emergency management plan that is consistent with
7033	the criteria in this subsection and with the local special needs
7034	plan. The plan shall be updated annually. The plan shall specify
7035	how the nurse registry shall facilitate the provision of
7036	continuous care by persons referred for contract to persons who
7037	are registered pursuant to s. 252.355 during an emergency that
7038	interrupts the provision of care or services in private
7039	residencies.
7040	(a)  All persons referred for contract who care for persons
7041	registered pursuant to s. 252.355 must include in the patient
7042	record a description of how care will be continued during a
7043	disaster or emergency that interrupts the provision of care in
7044	the patient's home. It shall be the responsibility of the person
7045	referred for contract to ensure that continuous care is
7046	provided.
7047	(b)  Each nurse registry shall maintain a current
7048	prioritized list of patients in private residences who are
7049	registered pursuant to s. 252.355 and are under the care of
7050	persons referred for contract and who need continued services
7051	during an emergency. This list shall indicate, for each patient,
7052	if the client is to be transported to a special needs shelter
7053	and if the patient is receiving skilled nursing services. Nurse
7054	registries shall make this list available to county health
7055	departments and to local emergency management agencies upon
7056	request.
7057	(c)  Each person referred for contract who is caring for a
7058	patient who is registered pursuant to s. 252.355 shall provide a
7059	list of the patient's medication and equipment needs to the
7060	nurse registry. Each person referred for contract shall make
7061	this information available to county health departments and to
7062	local emergency management agencies upon request.
7063	(d)  Each person referred for contract shall not be
7064	required to continue to provide care to patients in emergency
7065	situations that are beyond the person's control and that make it
7066	impossible to provide services, such as when roads are
7067	impassable or when patients do not go to the location specified
7068	in their patient records.
7069	(e)  The comprehensive emergency management plan required
7070	by this subsection is subject to review and approval by the
7071	county health department. During its review, the county health
7072	department shall ensure that, at a minimum, the local emergency
7073	management agency, the Agency for Health Care Administration,
7074	and the local chapter of the American Red Cross or other lead
7075	sheltering agency are given the opportunity to review the plan.
7076	The county health department shall complete its review within 60
7077	days after receipt of the plan and shall either approve the plan
7078	or advise the nurse registry of necessary revisions.
7079	(f)  The Agency for Health Care Administration shall adopt
7080	rules establishing minimum criteria for the comprehensive
7081	emergency management plan and plan updates required by this
7082	subsection, with the concurrence of the Department of Health and
7083	in consultation with the Department of Community Affairs.
7084	(12)(17)  All persons referred for contract in private
7085	residences by a nurse registry must comply with the following
7086	requirements for a plan of treatment:
7087	(a)  When, in accordance with the privileges and
7088	restrictions imposed upon a nurse under part I of chapter 464,
7089	the delivery of care to a patient is under the direction or
7090	supervision of a physician or when a physician is responsible
7091	for the medical care of the patient, a medical plan of treatment
7092	must be established for each patient receiving care or treatment
7093	provided by a licensed nurse in the home. The original medical
7094	plan of treatment must be timely signed by the physician,
7095	physician assistant, or advanced registered nurse practitioner,
7096	acting within his or her respective scope of practice, and
7097	reviewed by him or her in consultation with the licensed nurse
7098	at least every 2 months. Any additional order or change in
7099	orders must be obtained from the physician, physician assistant,
7100	or advanced registered nurse practitioner and reduced to writing
7101	and timely signed by the physician, physician assistant, or
7102	advanced registered nurse practitioner. The delivery of care
7103	under a medical plan of treatment must be substantiated by the
7104	appropriate nursing notes or documentation made by the nurse in
7105	compliance with nursing practices established under part I of
7106	chapter 464.
7107	(b)  Whenever a medical plan of treatment is established
7108	for a patient, the initial medical plan of treatment, any
7109	amendment to the plan, additional order or change in orders, and
7110	copy of nursing notes must be filed in the office of the nurse
7111	registry.
7112	(13)(18)  The nurse registry must comply with the notice
7113	requirements of s. 400.495, relating to abuse reporting.
7114	(14)(19)  In addition to any other penalties imposed
7115	pursuant to this section or part, the agency may assess costs
7116	related to an investigation that results in a successful
7117	prosecution., excluding costs associated with an attorney's
7118	time. If the agency imposes such an assessment and the
7119	assessment is not paid, and if challenged is not the subject of
7120	a pending appeal, prior to the renewal of the license, the
7121	license shall not be issued until the assessment is paid or
7122	arrangements for payment of the assessment are made.
7123	(15)(20)  The Agency for Health Care Administration shall
7124	adopt rules to implement this section and part II of chapter
7125	408.
7126	Section 126.  Section 400.509, Florida Statutes, is amended
7127	to read:
7128	400.509  Registration of particular service providers
7129	exempt from licensure; certificate of registration; regulation
7130	of registrants.--
7131	(1)  Any organization that provides companion services or
7132	homemaker services and does not provide a home health service to
7133	a person is exempt from licensure under this part. However, any
7134	organization that provides companion services or homemaker
7135	services must register with the agency.
7136	(2)  The requirements of part II of chapter 408 shall apply
7137	to the provision of services that require registration or
7138	licensure pursuant to this section and part II of chapter 408
7139	and entities registered by or applying for such registration
7140	from the Agency for Health Care Administration pursuant to this
7141	section. Each applicant for registration and each registrant
7142	must comply with all provisions of part II of chapter 408 except
7143	ss. 408.806(1)(e) and 408.810(6)-(10). Registration consists of
7144	annually filing with the agency, under oath, on forms provided
7145	by it, the following information:
7146	(a)  If the registrant is a firm or partnership, the name,
7147	address, date of birth, and social security number of every
7148	member.
7149	(b)  If the registrant is a corporation or association, its
7150	name and address; the name, address, date of birth, and social
7151	security number of each of its directors and officers; and the
7152	name and address of each person having at least a 5 percent
7153	interest in the corporation or association.
7154	(c)  The name, address, date of birth, and social security
7155	number of each person employed by or under contract with the
7156	organization.
7157	(3)  In accordance with s. 408.805, applicants and
7158	registrants shall pay fees for all registrations issued under
7159	this part, part II of chapter 408, and applicable rules. The
7160	amount of the fee shall be $50 per biennium. The agency shall
7161	charge a registration fee of $25 to be submitted with the
7162	information required under subsection (2).
7163	(4)  Each applicant for registration must comply with the
7164	following requirements:
7165	(a)  Upon receipt of a completed, signed, and dated
7166	application, the agency shall require background screening, in
7167	accordance with the level 1 standards for screening set forth in
7168	chapter 435, of every individual who will have contact with the
7169	client. The agency shall require background screening of the
7170	managing employee or other similarly titled individual who is
7171	responsible for the operation of the entity, and of the
7172	financial officer or other similarly titled individual who is
7173	responsible for the financial operation of the entity, including
7174	billings for client services in accordance with the level 2
7175	standards for background screening as set forth in chapter 435.
7176	(b)  The agency may require background screening of any
7177	other individual who is affiliated with the applicant if the
7178	agency has a reasonable basis for believing that he or she has
7179	been convicted of a crime or has committed any other offense
7180	prohibited under the level 2 standards for screening set forth
7181	in chapter 435.
7182	(c)  Proof of compliance with the level 2 background
7183	screening requirements of chapter 435 which has been submitted
7184	within the previous 5 years in compliance with any other health
7185	care or assisted living licensure requirements of this state is
7186	acceptable in fulfillment of paragraph (a).
7187	(d)  A provisional registration may be granted to an
7188	applicant when each individual required by this section to
7189	undergo background screening has met the standards for the
7190	abuse-registry background check through the agency and the
7191	Department of Law Enforcement background check, but the agency
7192	has not yet received background screening results from the
7193	Federal Bureau of Investigation. A standard registration may be
7194	granted to the applicant upon the agency's receipt of a report
7195	of the results of the Federal Bureau of Investigation background
7196	screening for each individual required by this section to
7197	undergo background screening which confirms that all standards
7198	have been met, or upon the granting of a disqualification
7199	exemption by the agency as set forth in chapter 435. Any other
7200	person who is required to undergo level 2 background screening
7201	may serve in his or her capacity pending the agency's receipt of
7202	the report from the Federal Bureau of Investigation. However,
7203	the person may not continue to serve if the report indicates any
7204	violation of background screening standards and if a
7205	disqualification exemption has not been requested of and granted
7206	by the agency as set forth in chapter 435.
7207	(e)  Each applicant must submit to the agency, with its
7208	application, a description and explanation of any exclusions,
7209	permanent suspensions, or terminations of the applicant from the
7210	Medicare or Medicaid programs. Proof of compliance with the
7211	requirements for disclosure of ownership and control interests
7212	under the Medicaid or Medicare programs may be accepted in lieu
7213	of this submission.
7214	(f)  Each applicant must submit to the agency a description
7215	and explanation of any conviction of an offense prohibited under
7216	the level 2 standards of chapter 435 which was committed by a
7217	member of the board of directors of the applicant, its officers,
7218	or any individual owning 5 percent or more of the applicant.
7219	This requirement does not apply to a director of a not-for-
7220	profit corporation or organization who serves solely in a
7221	voluntary capacity for the corporation or organization, does not
7222	regularly take part in the day-to-day operational decisions of
7223	the corporation or organization, receives no remuneration for
7224	his or her services on the corporation's or organization's board
7225	of directors, and has no financial interest and no family
7226	members having a financial interest in the corporation or
7227	organization, if the director and the not-for-profit corporation
7228	or organization include in the application a statement affirming
7229	that the director's relationship to the corporation satisfies
7230	the requirements of this paragraph.
7231	(g)  A registration may not be granted to an applicant if
7232	the applicant or managing employee has been found guilty of,
7233	regardless of adjudication, or has entered a plea of nolo
7234	contendere or guilty to, any offense prohibited under the level
7235	2 standards for screening set forth in chapter 435, unless an
7236	exemption from disqualification has been granted by the agency
7237	as set forth in chapter 435.
7238	(h)  The agency may deny or revoke the registration of any
7239	applicant who:
7240	1.  Has falsely represented a material fact in the
7241	application required by paragraph (e) or paragraph (f), or has
7242	omitted any material fact from the application required by
7243	paragraph (e) or paragraph (f); or
7244	2.  Has had prior action taken against the applicant under
7245	the Medicaid or Medicare program as set forth in paragraph (e).
7246	(i)  An application for licensure renewal must contain the
7247	information required under paragraphs (e) and (f).
7248	(4)(5)  Each registrant must obtain the employment or
7249	contract history of persons who are employed by or under
7250	contract with the organization and who will have contact at any
7251	time with patients or clients in their homes by:
7252	(a)  Requiring such persons to submit an employment or
7253	contractual history to the registrant; and
7254	(b)  Verifying the employment or contractual history,
7255	unless through diligent efforts such verification is not
7256	possible. The agency shall prescribe by rule the minimum
7257	requirements for establishing that diligent efforts have been
7258	made.
7259
7260	There is no monetary liability on the part of, and no cause of
7261	action for damages arises against, a former employer of a
7262	prospective employee of or prospective independent contractor
7263	with a registrant who reasonably and in good faith communicates
7264	his or her honest opinions about the former employee's or
7265	contractor's job performance. This subsection does not affect
7266	the official immunity of an officer or employee of a public
7267	corporation.
7268	(6)  On or before the first day on which services are
7269	provided to a patient or client, any registrant under this part
7270	must inform the patient or client and his or her immediate
7271	family, if appropriate, of the right to report abusive,
7272	neglectful, or exploitative practices. The statewide toll-free
7273	telephone number for the central abuse hotline must be provided
7274	to patients or clients in a manner that is clearly legible and
7275	must include the words: "To report abuse, neglect, or
7276	exploitation, please call toll-free   (phone number)  ."
7277	Registrants must establish appropriate policies and procedures
7278	for providing such notice to patients or clients.
7279	(7)  The provisions of s. 400.512 regarding screening apply
7280	to any person or business entity registered under this section
7281	on or after October 1, 1994.
7282	(8)  Upon verification that all requirements for
7283	registration have been met, the Agency for Health Care
7284	Administration shall issue a certificate of registration valid
7285	for no more than 1 year.
7286	(9)  The Agency for Health Care Administration may deny,
7287	suspend, or revoke the registration of a person that:
7288	(a)  Fails to comply with this section or applicable rules.
7289	(b)  Commits an intentional, reckless, or negligent act
7290	that materially affects the health or safety of a person
7291	receiving services.
7292	(10)  The Agency for Health Care Administration may
7293	institute injunctive proceedings under s. 400.515.
7294	(5)(11)  A person that offers or advertises to the public a
7295	service for which registration is required must include in its
7296	advertisement the registration number issued by the Agency for
7297	Health Care Administration.
7298	(12)  It is unlawful for a person to offer or advertise to
7299	the public services, as defined by rule, without obtaining a
7300	certificate of registration from the Agency for Health Care
7301	Administration. It is unlawful for any holder of a certificate
7302	of registration to advertise or hold out to the public that he
7303	or she holds a certificate of registration for other than that
7304	for which he or she actually holds a certificate of
7305	registration. Any person who violates this subsection is subject
7306	to injunctive proceedings under s. 400.515.
7307	(13)  Any duly authorized officer or employee of the Agency
7308	for Health Care Administration has the right to make such
7309	inspections and investigations as are necessary in order to
7310	respond to complaints or to determine the state of compliance
7311	with this section and applicable rules.
7312	(a)  If, in responding to a complaint, an officer or
7313	employee of the Agency for Health Care Administration has reason
7314	to believe that a crime has been committed, he or she shall
7315	notify the appropriate law enforcement agency.
7316	(b)  If, in responding to a complaint, an officer or
7317	employee of the Agency for Health Care Administration has reason
7318	to believe that abuse, neglect, or exploitation has occurred,
7319	according to the definitions in chapter 415, he or she shall
7320	file a report under chapter 415.
7321	(6)(14)  In addition to any other penalties imposed
7322	pursuant to this section or part, the agency may assess costs
7323	related to an investigation that results in a successful
7324	prosecution, excluding costs associated with an attorney's time.
7325	If the agency imposes such an assessment and the assessment is
7326	not paid, and if challenged is not the subject of a pending
7327	appeal, prior to the renewal of the registration, the
7328	registration shall not be issued until the assessment is paid or
7329	arrangements for payment of the assessment are made.
7330	(7)(15)  The Agency for Health Care Administration shall
7331	adopt rules to administer this section and part II of chapter
7332	408.
7333	Section 127.  Subsections (3) through (7) of section
7334	400.512, Florida Statutes, are renumbered as subsections (2)
7335	through (6) and present subsections (2) and (7) are amended to
7336	read:
7337	400.512  Screening of home health agency personnel; nurse
7338	registry personnel; and companions and homemakers.--The agency
7339	shall require employment or contractor screening as provided in
7340	chapter 435, using the level 1 standards for screening set forth
7341	in that chapter, for home health agency personnel; persons
7342	referred for employment by nurse registries; and persons
7343	employed by companion or homemaker services registered under s.
7344	400.509.
7345	(2)  The administrator of each home health agency, the
7346	managing employee of each nurse registry, and the managing
7347	employee of each companion or homemaker service registered under
7348	s. 400.509 must sign an affidavit annually, under penalty of
7349	perjury, stating that all personnel hired, contracted with, or
7350	registered on or after October 1, 1994, who enter the home of a
7351	patient or client in their service capacity have been screened
7352	and that its remaining personnel have worked for the home health
7353	agency or registrant continuously since before October 1, 1994.
7354	(6)(7)(a)  It is a misdemeanor of the first degree,
7355	punishable under s. 775.082 or s. 775.083, for any person
7356	willfully, knowingly, or intentionally to:
7357	1.  Fail, by false statement, misrepresentation,
7358	impersonation, or other fraudulent means, to disclose in any
7359	application for voluntary or paid employment a material fact
7360	used in making a determination as to such person's
7361	qualifications to be an employee under this section; or
7362	2.  Operate or attempt to operate an entity licensed or
7363	registered under this part with persons who do not meet the
7364	minimum standards for good moral character as contained in this
7365	section; or
7366	2.3.  Use information from the criminal records obtained
7367	under this section for any purpose other than screening that
7368	person for employment as specified in this section or release
7369	such information to any other person for any purpose other than
7370	screening for employment under this section.
7371	(b)  It is a felony of the third degree, punishable under
7372	s. 775.082, s. 775.083, or s. 775.084, for any person willfully,
7373	knowingly, or intentionally to use information from the juvenile
7374	records of a person obtained under this section for any purpose
7375	other than screening for employment under this section.
7376	Section 128.  Section 400.515, Florida Statutes, is
7377	repealed.
7378	Section 129.  Subsections (6) and (7) of section 400.551,
7379	Florida Statutes, are amended to read:
7380	400.551  Definitions.--As used in this part, the term:
7381	(6)  "Operator" means the licensee or person having general
7382	administrative charge of an adult day care center.
7383	(7)  "Owner" means the licensee owner of an adult day care
7384	center.
7385	Section 130.  Section 400.554, Florida Statutes, is amended
7386	to read:
7387	400.554  License requirement; fee; exemption; display.--
7388	(1)  The requirements of part II of chapter 408 shall apply
7389	to the provision of services that require licensure pursuant
7390	this part and part II of chapter 408 and to entities licensed by
7391	or applying for such licensure from the Agency for Health Care
7392	Administration pursuant this part. However, each applicant for
7393	licensure and each licensee is exempt from the provisions of s.
7394	408.810(10). It is unlawful to operate an adult day care center
7395	without first obtaining from the agency a license authorizing
7396	such operation. The agency is responsible for licensing adult
7397	day care centers in accordance with this part.
7398	(2)  Separate licenses are required for centers operated on
7399	separate premises, even though operated under the same
7400	management. Separate licenses are not required for separate
7401	buildings on the same premises.
7402	(3)  In accordance with s. 408.805, an applicant or
7403	licensee shall pay a fee for each license application submitted
7404	under this part and part II of chapter 408. The amount of the
7405	fee shall be established by rule and The biennial license fee
7406	required of a center shall be determined by the department, but
7407	may not exceed $150.
7408	(4)  County-operated or municipally operated centers
7409	applying for licensure under this part are exempt from the
7410	payment of license fees.
7411	(5)  The license for a center shall be displayed in a
7412	conspicuous place inside the center.
7413	(6)  A license is valid only in the possession of the
7414	individual, firm, partnership, association, or corporation to
7415	which it is issued and is not subject to sale, assignment, or
7416	other transfer, voluntary or involuntary; nor is a license valid
7417	for any premises other than the premises for which originally
7418	issued.
7419	Section 131.  Section 400.555, Florida Statutes, is amended
7420	to read:
7421	400.555  Application for license.--
7422	(1)  An application for a license to operate an adult day
7423	care center must be made to the agency on forms furnished by the
7424	agency and must be accompanied by the appropriate license fee
7425	unless the applicant is exempt from payment of the fee as
7426	provided in s. 400.554(4).
7427	(2)  In addition to all provisions of part II of chapter
7428	408, the applicant for licensure must furnish:
7429	(a)  a description of the physical and mental capabilities
7430	and needs of the participants to be served and the availability,
7431	frequency, and intensity of basic services and of supportive and
7432	optional services to be provided and proof of adequate liability
7433	insurance coverage.;
7434	(b)  Satisfactory proof of financial ability to operate and
7435	conduct the center in accordance with the requirements of this
7436	part, which must include, in the case of an initial application,
7437	a 1-year operating plan and proof of a 3-month operating reserve
7438	fund; and
7439	(c)  Proof of adequate liability insurance coverage.
7440	(d)  Proof of compliance with level 2 background screening
7441	as required under s. 400.5572.
7442	(e)  A description and explanation of any exclusions,
7443	permanent suspensions, or terminations of the application from
7444	the Medicare or Medicaid programs. Proof of compliance with
7445	disclosure of ownership and control interest requirements of the
7446	Medicare or Medicaid programs shall be accepted in lieu of this
7447	submission.
7448	Section 132.  Section 400.556, Florida Statutes, is amended
7449	to read:
7450	400.556  Denial, suspension, revocation of license;
7451	emergency action; administrative fines; investigations and
7452	inspections.--
7453	(1)  The agency may deny, revoke, or suspend a license
7454	under this part, impose an action under s. 408.814, and or may
7455	impose an administrative fine against the owner of an adult day
7456	care center or its operator or employee in the manner provided
7457	in chapter 120 for the violation of any provision of this part,
7458	part II of chapter 408, or applicable rules.
7459	(2)  Each of the following actions by the owner of an adult
7460	day care center or by its operator or employee is a ground for
7461	action by the agency against the owner of the center or its
7462	operator or employee:
7463	(a)  An intentional or negligent act materially affecting
7464	the health or safety of center participants.
7465	(b)  A violation of this part or of any standard or rule
7466	under this part.
7467	(b)(c)  A failure of persons subject to level 2 background
7468	screening under s. 408.809 400.4174(1) to meet the screening
7469	standards of s. 435.04, or the retention by the center of an
7470	employee subject to level 1 background screening standards under
7471	s. 400.4174(2) who does not meet the screening standards of s.
7472	435.03 and for whom exemptions from disqualification have not
7473	been provided by the agency.
7474	(c)(d)  Failure to follow the criteria and procedures
7475	provided under part I of chapter 394 relating to the
7476	transportation, voluntary admission, and involuntary examination
7477	of center participants.
7478	(d)(e)  Multiple or repeated violations of this part or of
7479	any standard or rule adopted under this part or part II of
7480	chapter 408.
7481	(f)  Exclusion, permanent suspension, or termination of the
7482	owner, if an individual, officer, or board member of the adult
7483	day care center, if the owner is a firm, corporation,
7484	partnership, or association, or any person owning 5 percent or
7485	more of the center, from the Medicare or Medicaid program.
7486	(3)  The agency is responsible for all investigations and
7487	inspections conducted pursuant to this part.
7488	Section 133.  Section 400.5565, Florida Statutes, is
7489	amended to read:
7490	400.5565  Administrative fines; interest.--
7491	(1)(a)  If the agency determines that an adult day care
7492	center is not operated in compliance with this part, part II of
7493	chapter 408, or applicable with rules adopted under this part,
7494	the agency, notwithstanding any other administrative action it
7495	takes, shall make a reasonable attempt to discuss with the owner
7496	each violation and recommended corrective action prior to
7497	providing the owner with written notification. The agency may
7498	request the submission of a corrective action plan for the
7499	center which demonstrates a good faith effort to remedy each
7500	violation by a specific date, subject to the approval of the
7501	agency.
7502	(b)  The owner of a center or its operator or employee
7503	found in violation of this part, part II of chapter 408, or
7504	applicable rules or of rules adopted under this part may be
7505	fined by the agency. A fine may not exceed $500 for each
7506	violation. In no event, however, may such fines in the aggregate
7507	exceed $5,000.
7508	(c)  The failure to correct a violation by the date set by
7509	the agency, or the failure to comply with an approved corrective
7510	action plan, is a separate violation for each day such failure
7511	continues, unless the agency approves an extension to a specific
7512	date.
7513	(d)  If the owner of a center or its operator or employee
7514	appeals an agency action under this section and the fine is
7515	upheld, the violator shall pay the fine, plus interest at the
7516	legal rate specified in s. 687.01 for each day that the fine
7517	remains unpaid after the date set by the agency for payment of
7518	the fine.
7519	(2)  In determining whether to impose a fine and in fixing
7520	the amount of any fine, the agency shall consider the following
7521	factors:
7522	(a)  The gravity of the violation, including the
7523	probability that death or serious physical or emotional harm to
7524	a participant will result or has resulted, the severity of the
7525	actual or potential harm, and the extent to which the provisions
7526	of the applicable statutes or rules were violated.
7527	(b)  Actions taken by the owner or operator to correct
7528	violations.
7529	(c)  Any previous violations.
7530	(d)  The financial benefit to the center of committing or
7531	continuing the violation.
7532	Section 134.  Section 400.557, Florida Statutes, is amended
7533	to read:
7534	400.557  Expiration of license; renewal; Conditional
7535	license or permit.--
7536	(1)  A license issued for the operation of an adult day
7537	care center, unless sooner suspended or revoked, expires 2 years
7538	after the date of issuance. The agency shall notify a licensee
7539	at least 120 days before the expiration date that license
7540	renewal is required to continue operation. The notification must
7541	be provided electronically or by mail delivery. At least 90 days
7542	prior to the expiration date, an application for renewal must be
7543	submitted to the agency. A license shall be renewed, upon the
7544	filing of an application on forms furnished by the agency, if
7545	the applicant has first met the requirements of this part and of
7546	the rules adopted under this part. The applicant must file with
7547	the application satisfactory proof of financial ability to
7548	operate the center in accordance with the requirements of this
7549	part and in accordance with the needs of the participants to be
7550	served and an affidavit of compliance with the background
7551	screening requirements of s. 400.5572.
7552	(2)  A licensee against whom a revocation or suspension
7553	proceeding is pending at the time for license renewal may be
7554	issued a conditional license effective until final disposition
7555	by the agency of the proceeding. If judicial relief is sought
7556	from the final disposition, the court having jurisdiction may
7557	issue a conditional permit effective for the duration of the
7558	judicial proceeding.
7559	(3)  The agency may issue a conditional license to an
7560	applicant for license renewal or change of ownership if the
7561	applicant fails to meet all standards and requirements for
7562	licensure. A conditional license issued under this subsection
7563	must be limited to a specific period not exceeding 6 months, as
7564	determined by the agency, and must be accompanied by an approved
7565	plan of correction.
7566	Section 135.  Section 400.5572, Florida Statutes, is
7567	amended to read:
7568	400.5572  Background screening.--
7569	(1)(a)  Level 2 background screening must be conducted on
7570	each of the following persons, who shall be considered employees
7571	for the purposes of conducting screening under chapter 435:
7572	1.  The adult day care center owner if an individual, the
7573	operator, and the financial officer.
7574	2.  An officer or board member if the owner of the adult
7575	day care center is a firm, corporation, partnership, or
7576	association, or any person owning 5 percent or more of the
7577	facility, if the agency has probable cause to believe that such
7578	person has been convicted of any offense prohibited by s.
7579	435.04. For each officer, board member, or person owning 5
7580	percent or more who has been convicted of any such offense, the
7581	facility shall submit to the agency a description and
7582	explanation of the conviction at the time of license
7583	application. This subparagraph does not apply to a board member
7584	of a not-for-profit corporation or organization if the board
7585	member serves solely in a voluntary capacity, does not regularly
7586	take part in the day-to-day operational decisions of the
7587	corporation or organization, receives no remuneration for his or
7588	her services, and has no financial interest and has no family
7589	members with a financial interest in the corporation or
7590	organization, provided that the board member and facility submit
7591	a statement affirming that the board member's relationship to
7592	the facility satisfies the requirements of this subparagraph.
7593	(b)  Proof of compliance with level 2 screening standards
7594	which has been submitted within the previous 5 years to meet any
7595	facility or professional licensure requirements of the agency or
7596	the Department of Health satisfies the requirements of this
7597	subsection.
7598	(c)  The agency may grant a provisional license to an adult
7599	day care center applying for an initial license when each
7600	individual required by this subsection to undergo screening has
7601	completed the Department of Law Enforcement background check,
7602	but has not yet received results from the Federal Bureau of
7603	Investigation, or when a request for an exemption from
7604	disqualification has been submitted to the agency pursuant to s.
7605	435.07, but a response has not been issued.
7606	(2)  The owner or administrator of an adult day care center
7607	must conduct level 1 background screening as set forth in
7608	chapter 435 on all employees hired on or after October 1, 1998,
7609	who provide basic services or supportive and optional services
7610	to the participants. Such persons satisfy this requirement if:
7611	(1)(a)  Proof of compliance with level 1 screening
7612	requirements obtained to meet any professional license
7613	requirements in this state is provided and accompanied, under
7614	penalty of perjury, by a copy of the person's current
7615	professional license and an affidavit of current compliance with
7616	the background screening requirements.
7617	(2)(b)  The person required to be screened has been
7618	continuously employed, without a breach in service that exceeds
7619	180 days, in the same type of occupation for which the person is
7620	seeking employment and provides proof of compliance with the
7621	level 1 screening requirement which is no more than 2 years old.
7622	Proof of compliance must be provided directly from one employer
7623	or contractor to another, and not from the person screened. Upon
7624	request, a copy of screening results shall be provided to the
7625	person screened by the employer retaining documentation of the
7626	screening.
7627	(3)(c)  The person required to be screened is employed by a
7628	corporation or business entity or related corporation or
7629	business entity that owns, operates, or manages more than one
7630	facility or agency licensed under this chapter, and for whom a
7631	level 1 screening was conducted by the corporation or business
7632	entity as a condition of initial or continued employment.
7633	Section 136.  Section 400.5575, Florida Statutes, is
7634	repealed.
7635	Section 137.  Section 400.558, Florida Statutes, is
7636	repealed.
7637	Section 138.  Section 400.559, Florida Statutes, is amended
7638	to read:
7639	400.559  Discontinuance of operation of adult day care
7640	centers Closing or change of owner or operator of center.--
7641	(1)  Before operation of an adult day care center may be
7642	voluntarily discontinued, the operator must inform the agency in
7643	writing at least 60 days prior to the discontinuance of
7644	operation. The operator must also, at such time, inform each
7645	participant of the fact and the proposed date of such
7646	discontinuance of operation.
7647	(2)  Immediately upon discontinuance of the operation of a
7648	center, the owner or operator shall surrender the license for
7649	the center to the agency, and the license shall be canceled by
7650	the agency.
7651	(3)  If a center has a change of ownership, the new owner
7652	shall apply to the agency for a new license at least 60 days
7653	before the date of the change of ownership.
7654	(4)  If a center has a change of operator, the new operator
7655	shall notify the agency in writing within 30 days after the
7656	change of operator.
7657	Section 139.  Section 400.56, Florida Statutes, is amended
7658	to read:
7659	400.56  Right of entry and inspection.--In accordance with
7660	s. 408.811, Any duly designated officer or employee of the
7661	agency or department has the right to enter the premises of any
7662	adult day care center licensed pursuant to this part, at any
7663	reasonable time, in order to determine the state of compliance
7664	with this part, part II of chapter 408, and applicable the rules
7665	or standards in force pursuant to this part. The right of entry
7666	and inspection also extends to any premises that the agency has
7667	reason to believe are being operated as a center without a
7668	license, but no entry or inspection of any unlicensed premises
7669	may be made without the permission of the owner or operator
7670	unless a warrant is first obtained from the circuit court
7671	authorizing entry or inspection. Any application for a center
7672	license or license renewal made pursuant to this part
7673	constitutes permission for, and complete acquiescence in, any
7674	entry or inspection of the premises for which the license is
7675	sought in order to facilitate verification of the information
7676	submitted on or in connection with the application.
7677	Section 140.  Section 400.562, Florida Statutes, is amended
7678	to read:
7679	400.562  Rules establishing standards.--
7680	(1)  The agency Department of Elderly Affairs, in
7681	conjunction with the Department of Elderly Affairs agency, shall
7682	adopt rules to implement the provisions of this part and part II
7683	of chapter 408. The rules must include reasonable and fair
7684	standards. Any conflict between these standards and those that
7685	may be set forth in local, county, or municipal ordinances shall
7686	be resolved in favor of those having statewide effect. Such
7687	standards must relate to:
7688	(a)  The maintenance of adult day care centers with respect
7689	to plumbing, heating, lighting, ventilation, and other building
7690	conditions, including adequate meeting space, to ensure the
7691	health, safety, and comfort of participants and protection from
7692	fire hazard. Such standards may not conflict with chapter 553
7693	and must be based upon the size of the structure and the number
7694	of participants.
7695	(b)  The number and qualifications of all personnel
7696	employed by adult day care centers who have responsibilities for
7697	the care of participants.
7698	(c)  All sanitary conditions within adult day care centers
7699	and their surroundings, including water supply, sewage disposal,
7700	food handling, and general hygiene, and maintenance of sanitary
7701	conditions, to ensure the health and comfort of participants.
7702	(d)  Basic services provided by adult day care centers.
7703	(e)  Supportive and optional services provided by adult day
7704	care centers.
7705	(f)  Data and information relative to participants and
7706	programs of adult day care centers, including, but not limited
7707	to, the physical and mental capabilities and needs of the
7708	participants, the availability, frequency, and intensity of
7709	basic services and of supportive and optional services provided,
7710	the frequency of participation, the distances traveled by
7711	participants, the hours of operation, the number of referrals to
7712	other centers or elsewhere, and the incidence of illness.
7713	(g)  Components of a comprehensive emergency management
7714	plan, developed in consultation with the Department of Health,
7715	the Department of Elderly Affairs Agency for Health Care
7716	Administration, and the Department of Community Affairs.
7717	(2)  Pursuant to s. 119.07, the agency may charge a fee for
7718	furnishing a copy of this part, or of the rules adopted under
7719	this part, to any person upon request for the copy.
7720	(2)(3)  Pursuant to this part, s. 408.811, and applicable
7721	rules adopted by the department, the agency may conduct an
7722	abbreviated biennial inspection of key quality-of-care
7723	standards, in lieu of a full inspection, of a center that has a
7724	record of good performance. However, the agency must conduct a
7725	full inspection of a center that has had one or more confirmed
7726	complaints within the licensure period immediately preceding the
7727	inspection or which has a serious problem identified during the
7728	abbreviated inspection. The agency shall by rule develop the key
7729	quality-of-care standards, taking into consideration the
7730	comments and recommendations of the Department of Elderly
7731	Affairs and of provider groups. These standards shall be
7732	included in rules adopted by the Department of Elderly Affairs.
7733	Section 141.  Section 400.564, Florida Statutes, is
7734	repealed.
7735	Section 142.  Section 400.602, Florida Statutes, is amended
7736	to read:
7737	400.602  Licensure required; prohibited acts; exemptions;
7738	display, transferability of license.--
7739	(1)(a)  The requirements of part II of chapter 408 shall
7740	apply to the provision of services that require licensure
7741	pursuant to this part and part II of chapter 408 and to entities
7742	licensed by or applying for such licensure from the agency
7743	pursuant to this part. It is unlawful to operate or maintain a
7744	hospice without first obtaining a license from the agency.
7745	(b)  It is unlawful for Any person or legal entity not
7746	licensed as a hospice under this part may not to use the word
7747	"hospice" in its name, or to offer or advertise hospice services
7748	or hospice-like services in such a way as to mislead a person to
7749	believe that the offeror is a hospice licensed under this part.
7750	(2)  Services provided by a hospital, nursing home, or
7751	other health care facility, health care provider, or caregiver,
7752	or under the Community Care for the Elderly Act, do not
7753	constitute a hospice unless the facility, provider, or caregiver
7754	establishes a separate and distinct administrative program to
7755	provide home, residential, and homelike inpatient hospice
7756	services.
7757	(3)(a)  A separately licensed hospice may not use a name
7758	which is substantially the same as the name of another hospice
7759	licensed under this part.
7760	(b)  A licensed hospice which intends to change its name or
7761	address must notify the agency at least 60 days before making
7762	the change.
7763	(4)  The license shall be displayed in a conspicuous place
7764	inside the hospice program office; shall be valid only in the
7765	possession of the person or public agency to which it is issued;
7766	shall not be subject to sale, assignment, or other transfer,
7767	voluntary or involuntary; and shall not be valid for any hospice
7768	other than the hospice for which originally issued.
7769	(4)(5)  Notwithstanding s. 400.601(3), any hospice
7770	operating in corporate form exclusively as a hospice,
7771	incorporated on or before July 1, 1978, may be transferred to a
7772	for-profit or not-for-profit entity, and may transfer the
7773	license to that entity.
7774	(5)(6)  Notwithstanding s. 400.601(3), at any time after
7775	July 1, 1995, any entity entitled to licensure under subsection
7776	(5) may obtain a license for up to two additional hospices in
7777	accordance with the other requirements of this part and upon
7778	receipt of any certificate of need that may be required under
7779	the provisions of part I of chapter 408 ss. 408.031-408.045.
7780	Section 143.  Section 400.605, Florida Statutes, is amended
7781	to read:
7782	400.605  Administration; forms; fees; rules; inspections;
7783	fines.--
7784	(1)  The agency department, in consultation with the
7785	department agency, shall by rule establish minimum standards and
7786	procedures for a hospice pursuant to this part and part II of
7787	chapter 408. The rules must include:
7788	(a)  License application procedures and requirements.
7789	(a)(b)  The qualifications of professional and ancillary
7790	personnel to ensure the provision of appropriate and adequate
7791	hospice care.
7792	(b)(c)  Standards and procedures for the administrative
7793	management of a hospice.
7794	(c)(d)  Standards for hospice services that ensure the
7795	provision of quality patient care.
7796	(d)(e)  Components of a patient plan of care.
7797	(e)(f)  Procedures relating to the implementation of
7798	advanced directives and do-not-resuscitate orders.
7799	(f)(g)  Procedures for maintaining and ensuring
7800	confidentiality of patient records.
7801	(g)(h)  Standards for hospice care provided in freestanding
7802	inpatient facilities that are not otherwise licensed medical
7803	facilities and in residential care facilities such as nursing
7804	homes, assisted living facilities, adult family care homes, and
7805	hospice residential units and facilities.
7806	(h)(i)  Physical plant standards for hospice residential
7807	and inpatient facilities and units.
7808	(i)(j)  Components of a comprehensive emergency management
7809	plan, developed in consultation with the Department of Health,
7810	the Department of Elderly Affairs, and the Department of
7811	Community Affairs.
7812	(j)(k)  Standards and procedures relating to the
7813	establishment and activities of a quality assurance and
7814	utilization review committee.
7815	(k)(l)  Components and procedures relating to the
7816	collection of patient demographic data and other information on
7817	the provision of hospice care in this state.
7818	(2)  In accordance with s. 408.805, an applicant or
7819	licensee shall pay a fee for each license application submitted
7820	under this part, part II of chapter 408, and applicable rules.
7821	The amount of the fee shall be established by rule and may not
7822	exceed $1,200 per biennium. The agency shall:
7823	(a)  Prepare and furnish all forms necessary under the
7824	provisions of this part in relation to applications for
7825	licensure or licensure renewals.
7826	(b)  Collect from the applicant at the time of filing an
7827	application for a license or at the time of renewal of a license
7828	a fee which must be reasonably calculated to cover the cost of
7829	regulation under this part, but may not exceed $600 per program.
7830	All fees collected under this part shall be deposited in the
7831	Health Care Trust Fund for the administration of this part.
7832	(c)  Issue hospice licenses to all applicants which meet
7833	the provisions of this part and applicable rules.
7834	(3)(d)  In accordance with s. 408.811, the agency shall
7835	conduct annual licensure inspections of all licensees, except
7836	that licensure inspections may be conducted biennially for
7837	hospices having a 3-year record of substantial compliance. The
7838	agency shall
7839	(e)  conduct such inspections and investigations as are
7840	necessary in order to determine the state of compliance with the
7841	provisions of this part, part II of chapter 408, and applicable
7842	adopted rules. The right of inspection also extends to any
7843	program that the agency has reason to believe is offering or
7844	advertising itself as a hospice without a license, but no
7845	inspection may be made without the permission of the owner or
7846	person in charge thereof unless a warrant is first obtained from
7847	a circuit court authorizing such inspection. An application for
7848	a license or license renewal made pursuant to this part
7849	constitutes permission for an inspection of the hospice for
7850	which the license is sought in order to facilitate verification
7851	of the information submitted on or in connection with the
7852	application.
7853	(4)(f)  In accordance with part II of chapter 408, the
7854	agency may impose an administrative fine for any violation of
7855	the provisions of this part, part II of chapter 408, or
7856	applicable rules.
7857	Section 144.  Section 400.606, Florida Statutes, is amended
7858	to read:
7859	400.606  License; application; renewal; conditional license
7860	or permit; certificate of need.--
7861	(1)  A license application must be filed on a form provided
7862	by the agency and must be accompanied by the appropriate license
7863	fee as well as satisfactory proof that the hospice is in
7864	compliance with this part and any rules adopted by the
7865	department and proof of financial ability to operate and conduct
7866	the hospice in accordance with the requirements of this part.
7867	The initial application and change of ownership application must
7868	be accompanied by a plan for the delivery of home, residential,
7869	and homelike inpatient hospice services to terminally ill
7870	persons and their families. Such plan must contain, but need not
7871	be limited to:
7872	(a)  The estimated average number of terminally ill persons
7873	to be served monthly.
7874	(b)  The geographic area in which hospice services will be
7875	available.
7876	(c)  A listing of services which are or will be provided,
7877	either directly by the applicant or through contractual
7878	arrangements with existing providers.
7879	(d)  Provisions for the implementation of hospice home care
7880	within 3 months after licensure.
7881	(e)  Provisions for the implementation of hospice homelike
7882	inpatient care within 12 months after licensure.
7883	(f)  The number and disciplines of professional staff to be
7884	employed.
7885	(g)  The name and qualifications of any existing or
7886	potential contractee.
7887	(h)  A plan for attracting and training volunteers.
7888	(i)  The projected annual operating cost of the hospice.
7889	(j)  A statement of financial resources and personnel
7890	available to the applicant to deliver hospice care.
7891
7892	If the applicant is an existing licensed health care provider,
7893	the application must be accompanied by a copy of the most recent
7894	profit-loss statement and, if applicable, the most recent
7895	licensure inspection report.
7896	(2)  Each applicant must submit to the agency with its
7897	application a description and explanation of any exclusions,
7898	permanent suspensions, or terminations from the Medicaid or
7899	Medicare programs of the owner, if an individual; of any officer
7900	or board member of the hospice, if the owner is a firm,
7901	corporation, partnership, or association; or of any person
7902	owning 5 percent or more of the hospice. Proof of compliance
7903	with disclosure of ownership and control interest requirements
7904	of the Medicaid or Medicare programs may be accepted in lieu of
7905	this submission.
7906	(2)(3)  A license issued for the operation of a hospice,
7907	unless sooner suspended or revoked, shall expire automatically 1
7908	year from the date of issuance. Sixty days prior to the
7909	expiration date, a hospice wishing to renew its license shall
7910	submit an application for renewal to the agency on forms
7911	furnished by the agency. The agency shall renew the license if
7912	the applicant has first met the requirements established under
7913	this part and all applicable rules and has provided the
7914	information described under this section in addition to the
7915	application. However, The application for license renewal shall
7916	be accompanied by an update of the plan for delivery of hospice
7917	care only if information contained in the plan submitted
7918	pursuant to subsection (1) is no longer applicable.
7919	(4)  A hospice against which a revocation or suspension
7920	proceeding is pending at the time of license renewal may be
7921	issued a conditional license by the agency effective until final
7922	disposition of such proceeding. If judicial relief is sought
7923	from the final agency action, the court having jurisdiction may
7924	issue a conditional permit for the duration of the judicial
7925	proceeding.
7926	(3)(5)  The agency shall not issue a license to a hospice
7927	that fails to receive a certificate of need under the provisions
7928	of part I of chapter 408 ss. 408.031-408.045. A licensed hospice
7929	is a health care facility as that term is used in s. 408.039(5)
7930	and is entitled to initiate or intervene in an administrative
7931	hearing.
7932	(4)(6)  A freestanding hospice facility that is primarily
7933	engaged in providing inpatient and related services and that is
7934	not otherwise licensed as a health care facility shall be
7935	required to obtain a certificate of need. However, a
7936	freestanding hospice facility with six or fewer beds shall not
7937	be required to comply with institutional standards such as, but
7938	not limited to, standards requiring sprinkler systems, emergency
7939	electrical systems, or special lavatory devices.
7940	Section 145.  Section 400.6065, Florida Statutes, is
7941	amended to read:
7942	400.6065  Background screening.--
7943	(1)  Upon receipt of a completed application under s.
7944	400.606, the agency shall require level 2 background screening
7945	on each of the following persons, who shall be considered
7946	employees for the purposes of conducting screening under chapter
7947	435:
7948	(a)  The hospice administrator and financial officer.
7949	(b)  An officer or board member if the hospice is a firm,
7950	corporation, partnership, or association, or any person owning 5
7951	percent or more of the hospice if the agency has probable cause
7952	to believe that such officer, board member, or owner has been
7953	convicted of any offense prohibited by s. 435.04. For each
7954	officer, board member, or person owning 5 percent or more who
7955	has been convicted of any such offense, the hospice shall submit
7956	to the agency a description and explanation of the conviction at
7957	the time of license application. This paragraph does not apply
7958	to a board member of a not-for-profit corporation or
7959	organization if the board member serves solely in a voluntary
7960	capacity, does not regularly take part in the day-to-day
7961	operational decisions of the corporation or organization,
7962	receives no remuneration for his or her services, and has no
7963	financial interest and has no family members with a financial
7964	interest in the corporation or organization, provided that the
7965	board member and the corporation or organization submit a
7966	statement affirming that the board member's relationship to the
7967	corporation or organization satisfies the requirements of this
7968	paragraph.
7969	(2)  Proof of compliance with level 2 screening standards
7970	which has been submitted within the previous 5 years to meet any
7971	facility or professional licensure requirements of the agency or
7972	the Department of Health satisfies the requirements of this
7973	section.
7974	(3)  The agency may grant a provisional license to a
7975	hospice applying for an initial license when each individual
7976	required by this section to undergo screening has completed the
7977	Department of Law Enforcement background check, but has not yet
7978	received results from the Federal Bureau of Investigation.
7979	(1)(4)  The agency shall require employment or contractor
7980	screening as provided in chapter 435, using the level 1
7981	standards for screening set forth in that chapter, for hospice
7982	personnel.
7983	(2)(5)  The agency may grant exemptions from
7984	disqualification from employment under this section as provided
7985	in s. 435.07.
7986	(6)  The administration of each hospice must sign an
7987	affidavit annually, under penalty of perjury, stating that all
7988	personnel employed or contracted with on or after October 1,
7989	1998, who provide hospice services in a facility, or who enter
7990	the home of a patient in their service capacity, have been
7991	screened.
7992	(3)(7)  Proof of compliance with the screening requirements
7993	of chapter 435 shall be accepted in lieu of the requirements of
7994	this section if the person has been continuously employed or
7995	registered without a breach in service that exceeds 180 days,
7996	the proof of compliance is not more than 2 years old, and the
7997	person has been screened, at the discretion of the hospice.
7998	(4)(8)(a)  It is a misdemeanor of the first degree,
7999	punishable under s. 775.082 or s. 775.083, for any person
8000	willfully, knowingly, or intentionally to:
8001	1.  Fail, by false statement, misrepresentation,
8002	impersonation, or other fraudulent means, to disclose in any
8003	application for voluntary or paid employment a material fact
8004	used in making a determination as to such person's
8005	qualifications to be employed or contracted with under this
8006	section;
8007	2.  Operate or attempt to operate an entity licensed under
8008	this part with persons who do not meet the minimum standards for
8009	good moral character as contained in this section; or
8010	2.3.  Use information from the criminal records obtained
8011	under this section for any purpose other than screening as
8012	specified in this section, or release such information to any
8013	other person for any purpose other than screening under this
8014	section.
8015	(b)  It is a felony of the third degree, punishable under
8016	s. 775.082, s. 775.083, or s. 775.084, for any person willfully,
8017	knowingly, or intentionally to use information from the juvenile
8018	records of a person obtained under this section for any purpose
8019	other than screening for employment under this section.
8020	Section 146.  Section 400.607, Florida Statutes, is amended
8021	to read:
8022	400.607  Denial, suspension, or revocation of license;
8023	emergency actions; imposition of administrative fine; grounds;
8024	injunctions.--
8025	(1)  The agency may deny, revoke, and or suspend a license,
8026	impose an action under s. 408.814, and or impose an
8027	administrative fine, which may not exceed $5,000 per violation,
8028	for the violation of any provision of this part, part II of
8029	chapter 408, or applicable rules in the manner provided in
8030	chapter 120.
8031	(2)  Any of the following actions by a licensed hospice or
8032	any of its employees shall be grounds for action by the agency
8033	against a hospice:
8034	(a)  A violation of the provisions of this part or
8035	applicable rules.
8036	(b)  An intentional or negligent act materially affecting
8037	the health or safety of a patient.
8038	(3)  The agency may deny or revoke a license upon a
8039	determination that:
8040	(a)  Persons subject to level 2 background screening under
8041	s. 400.6065 do not meet the screening standards of s. 435.04,
8042	and exemptions from disqualification have not been provided by
8043	the agency.
8044	(b)  An officer, board member, or person owning 5 percent
8045	or more of the hospice has been excluded, permanently suspended,
8046	or terminated from the Medicare or Medicaid programs.
8047	(3)(4)  If, 3 months after the date of obtaining a license,
8048	or at any time thereafter, a hospice does not have in operation
8049	the home-care component of hospice care, the agency shall
8050	immediately revoke the license of such hospice.
8051	(4)(5)  If, 12 months after the date of obtaining a license
8052	pursuant to s. 400.606, or at any time thereafter, a hospice
8053	does not have in operation the inpatient components of hospice
8054	care, the agency shall immediately revoke the license of such
8055	hospice.
8056	(6)  The agency may institute a civil action in a court of
8057	competent jurisdiction to seek injunctive relief to enforce
8058	compliance with this part or any rule adopted pursuant to this
8059	part.
8060	(5)(7)  The remedies set forth in this section are
8061	independent of and cumulative to other remedies provided by law.
8062	Section 147.  Subsection (8) of section 400.6095, Florida
8063	Statutes, is amended to read:
8064	400.6095  Patient admission; assessment; plan of care;
8065	discharge; death.--
8066	(8)  The hospice care team may withhold or withdraw
8067	cardiopulmonary resuscitation if presented with an order not to
8068	resuscitate executed pursuant to s. 401.45. The agency
8069	department shall adopt rules providing for the implementation of
8070	such orders. Hospice staff shall not be subject to criminal
8071	prosecution or civil liability, nor be considered to have
8072	engaged in negligent or unprofessional conduct, for withholding
8073	or withdrawing cardiopulmonary resuscitation pursuant to such an
8074	order and applicable rules adopted by the department. The
8075	absence of an order to resuscitate executed pursuant to s.
8076	401.45 does not preclude a physician from withholding or
8077	withdrawing cardiopulmonary resuscitation as otherwise permitted
8078	by law.
8079	Section 148.  Subsection (5) of section 400.617, Florida
8080	Statutes, is amended to read:
8081	400.617  Legislative intent; purpose.--
8082	(5)  Rules of the agency department relating to adult
8083	family-care homes shall be as minimal and flexible as possible
8084	to ensure the protection of residents while minimizing the
8085	obstacles that could inhibit the establishment of adult family-
8086	care homes.
8087	Section 149.  Section 400.619, Florida Statutes, is amended
8088	to read:
8089	400.619  Licensure application and renewal.--
8090	(1)  The requirements of part II of chapter 408 shall apply
8091	to the provision of services that require licensure pursuant to
8092	this part and part II of chapter 408 and to entities licensed by
8093	or applying for such licensure from the Agency for Health Care
8094	Administration pursuant to this part. However, each applicant
8095	for licensure and each licensee is exempt from s. 408.810(7)-
8096	(10). Each person who intends to be an adult family-care home
8097	provider must apply for a license from the agency at least 90
8098	days before the applicant intends to operate the adult family-
8099	care home.
8100	(2)  A person who intends to be an adult family-care home
8101	provider must own or rent the adult family-care home that is to
8102	be licensed and reside therein.
8103	(3)  In accordance with s. 408.805, an applicant or
8104	licensee shall pay a fee for each license application submitted
8105	under this part, part II of chapter 408, and applicable rules.
8106	The amount of the fee shall be $200 per biennium. The agency
8107	shall notify a licensee at least 120 days before the expiration
8108	date that license renewal is required to continue operation. The
8109	notification must be provided electronically or by mail
8110	delivery. Application for a license or annual license renewal
8111	must be made on a form provided by the agency, signed under
8112	oath, and must be accompanied by a licensing fee of $100 per
8113	year.
8114	(4)  Upon receipt of a completed license application or
8115	license renewal, and the fee, the agency shall initiate a level
8116	1 background screening as provided under chapter 435 on the
8117	adult family-care home provider, the designated relief person,
8118	all adult household members, and all staff members. The
8119	applicant or licensee is responsible for paying the fees
8120	associated with obtaining the required screening. The agency
8121	shall conduct an onsite visit to the home that is to be
8122	licensed.
8123	(a)  Proof of compliance with level 1 screening standards
8124	which has been submitted within the previous 5 years to meet any
8125	facility or professional licensure requirements of the agency or
8126	the Department of Health satisfies the requirements of this
8127	subsection. Such proof must be accompanied, under penalty of
8128	perjury, by a copy of the person's current professional license
8129	and an affidavit of current compliance with the background
8130	screening requirements.
8131	(b)  The person required to be screened must have been
8132	continuously employed in the same type of occupation for which
8133	the person is seeking employment without a breach in service
8134	that exceeds 180 days, and proof of compliance with the level 1
8135	screening requirement which is no more than 2 years old must be
8136	provided. Proof of compliance shall be provided directly from
8137	one employer or contractor to another, and not from the person
8138	screened. Upon request, a copy of screening results shall be
8139	provided to the person screened by the employer retaining
8140	documentation of the screening.
8141	(5)  The application must be accompanied by a description
8142	and explanation of any exclusions, permanent suspensions, or
8143	terminations of the applicant from participation in the Medicaid
8144	or Medicare programs or any other governmental health care or
8145	health insurance program.
8146	(6)  Unless the adult family-care home is a community
8147	residential home subject to chapter 419, the applicant must
8148	provide documentation, signed by the appropriate governmental
8149	official, that the home has met local zoning requirements for
8150	the location for which the license is sought.
8151	(5)(7)  Access to a licensed adult family-care home must be
8152	provided at reasonable times for the appropriate officials of
8153	the department, the Department of Health, the Department of
8154	Children and Family Services, the agency, and the State Fire
8155	Marshal, who are responsible for the development and maintenance
8156	of fire, health, sanitary, and safety standards, to inspect the
8157	facility to assure compliance with these standards. In addition,
8158	access to a licensed adult family-care home must be provided at
8159	reasonable times for the local long-term care ombudsman council.
8160	(8)  A license is effective for 1 year after the date of
8161	issuance unless revoked sooner. Each license must state the name
8162	of the provider, the address of the home to which the license
8163	applies, and the maximum number of residents of the home.
8164	Failure to timely file a license renewal application shall
8165	result in a late fee equal to 50 percent of the license fee.
8166	(9)  A license is not transferable or applicable to any
8167	location or person other than the location and person indicated
8168	on the license.
8169	(6)(10)  The licensed maximum capacity of each adult
8170	family-care home is based on the service needs of the residents
8171	and the capability of the provider to meet the needs of the
8172	residents. Any relative who lives in the adult family-care home
8173	and who is a disabled adult or frail elder must be included in
8174	that limitation.
8175	(7)(11)  Each adult family-care home must designate at
8176	least one licensed space for a resident receiving optional state
8177	supplementation. The Department of Children and Family Services
8178	shall specify by rule the procedures to be followed for
8179	referring residents who receive optional state supplementation
8180	to adult family-care homes. Those homes licensed as adult foster
8181	homes or assisted living facilities prior to January 1, 1994,
8182	that convert to adult family-care homes, are exempt from this
8183	requirement.
8184	(8)(12)  The agency may issue a conditional license to a
8185	provider for the purpose of bringing the adult family-care home
8186	into compliance with licensure requirements. A conditional
8187	license must be limited to a specific period, not exceeding 6
8188	months. The agency department shall, by rule, establish criteria
8189	for issuing conditional licenses.
8190	(13)  All moneys collected under this section must be
8191	deposited into the Department of Elderly Affairs Administrative
8192	Trust Fund.
8193	(9)(14)  The agency department may adopt rules to establish
8194	procedures, identify forms, specify documentation, and clarify
8195	terms, as necessary, to administer this section and part II of
8196	chapter 408.
8197	Section 150.  Section 400.6194, Florida Statutes, is
8198	amended to read:
8199	400.6194  Denial, revocation, or suspension of a
8200	license.--In addition to the requirements of part II of chapter
8201	408 the agency may deny, suspend, and or revoke a license for
8202	any of the following reasons:
8203	(1)  Failure of any of the persons required to undergo
8204	background screening under s. 400.619 to meet the level 1
8205	screening standards of s. 435.03, unless an exemption from
8206	disqualification has been provided by the agency.
8207	(2)  An intentional or negligent act materially affecting
8208	the health, safety, or welfare of the adult family-care home
8209	residents.
8210	(3)  Submission of fraudulent information or omission of
8211	any material fact on a license application or any other document
8212	required by the agency.
8213	(4)  Failure to pay an administrative fine assessed under
8214	this part.
8215	(5)  A violation of this part or adopted rules which
8216	results in conditions or practices that directly threaten the
8217	physical or emotional health, safety, or welfare of residents.
8218	(3)(6)  Failure to correct cited fire code violations that
8219	threaten the health, safety, or welfare of residents.
8220	(7)  Failure to submit a completed initial license
8221	application or to complete an application for license renewal
8222	within the specified timeframes.
8223	(8)  Exclusion, permanent suspension, or termination of the
8224	provider from the Medicare or Medicaid program.
8225	Section 151.  Section 400.6196, Florida Statutes, is
8226	amended to read:
8227	400.6196  Classification of deficiencies; administrative
8228	fines Violations; penalties.--
8229	(1)  In accordance with part II of chapter 408 and in
8230	addition to any other liability or penalty provided by law, the
8231	agency may impose an administrative fine a civil penalty on a
8232	provider according to the following classification for the
8233	violation of any provision of this part, part II of chapter 408,
8234	or applicable rules:
8235	(a)  Class I violations are those conditions or practices
8236	related to the operation and maintenance of an adult family-care
8237	home or to the care of residents which the agency determines
8238	present an imminent danger to the residents or guests of the
8239	facility or a substantial probability that death or serious
8240	physical or emotional harm would result therefrom. The condition
8241	or practice that constitutes a class I violation must be abated
8242	or eliminated within 24 hours, unless a fixed period, as
8243	determined by the agency, is required for correction. A class I
8244	deficiency is subject to an administrative fine in an amount not
8245	less than $500 and not exceeding $1,000 for each violation. A
8246	fine may be levied notwithstanding the correction of the
8247	deficiency.
8248	(b)  Class II violations are those conditions or practices
8249	related to the operation and maintenance of an adult family-care
8250	home or to the care of residents which the agency determines
8251	directly threaten the physical or emotional health, safety, or
8252	security of the residents, other than class I violations. A
8253	class II violation is subject to an administrative fine in an
8254	amount not less than $250 and not exceeding $500 for each
8255	violation. A citation for a class II violation must specify the
8256	time within which the violation is required to be corrected. If
8257	a class II violation is corrected within the time specified, no
8258	civil penalty shall be imposed, unless it is a repeated offense.
8259	(c)  Class III violations are those conditions or practices
8260	related to the operation and maintenance of an adult family-care
8261	home or to the care of residents which the agency determines
8262	indirectly or potentially threaten the physical or emotional
8263	health, safety, or security of residents, other than class I or
8264	class II violations. A class III violation is subject to an
8265	administrative fine in an amount not less than $100 and not
8266	exceeding $250 for each violation. A citation for a class III
8267	violation shall specify the time within which the violation is
8268	required to be corrected. If a class III violation is corrected
8269	within the time specified, no civil penalty shall be imposed,
8270	unless it is a repeated offense.
8271	(d)  Class IV violations are those conditions or
8272	occurrences related to the operation and maintenance of an adult
8273	family-care home, or related to the required reports, forms, or
8274	documents, which do not have the potential of negatively
8275	affecting the residents. A provider that does not correct a
8276	class IV violation within the time limit specified by the agency
8277	is subject to an administrative fine in an amount not less than
8278	$50 and not exceeding $100 for each violation. Any class IV
8279	violation that is corrected during the time the agency survey is
8280	conducted will be identified as an agency finding and not as a
8281	violation.
8282	(2)  The agency may impose an administrative fine for
8283	violations which do not qualify as class I, class II, class III,
8284	or class IV violations. The amount of the fine shall not exceed
8285	$250 for each violation or $2,000 in the aggregate. Unclassified
8286	violations include:
8287	(a)  Violating any term or condition of a license.
8288	(b)  Violating any provision of rule adopted under this
8289	part, part II of chapter 408, or applicable rules.
8290	(c)  Failure to follow the criteria and procedures provided
8291	under part I of chapter 394 relating to the transportation,
8292	voluntary admission, and involuntary examination of adult
8293	family-care home residents.
8294	(d)  Exceeding licensed capacity.
8295	(e)  Providing services beyond the scope of the license.
8296	(f)  Violating a moratorium.
8297	(3)  Each day during which a violation occurs constitutes a
8298	separate offense.
8299	(3)(4)  In determining whether a penalty is to be imposed,
8300	and in fixing the amount of any penalty to be imposed, the
8301	agency must consider:
8302	(a)  The gravity of the violation.
8303	(b)  Actions taken by the provider to correct a violation.
8304	(c)  Any previous violation by the provider.
8305	(d)  The financial benefit to the provider of committing or
8306	continuing the violation.
8307	(4)(5)  As an alternative to or in conjunction with an
8308	administrative action against a provider, the agency may request
8309	a plan of corrective action that demonstrates a good faith
8310	effort to remedy each violation by a specific date, subject to
8311	the approval of the agency.
8312	(5)(6)  The agency department shall set forth, by rule,
8313	notice requirements and procedures for correction of
8314	deficiencies.
8315	(7)  Civil penalties paid by a provider must be deposited
8316	into the Department of Elderly Affairs Administrative Trust Fund
8317	and used to offset the expenses of departmental training and
8318	education for adult family-care home providers.
8319	(8)  The agency may impose an immediate moratorium on
8320	admissions to any adult family-care home if the agency finds
8321	that a condition in the home presents a threat to the health,
8322	safety, or welfare of its residents. The department may by rule
8323	establish facility conditions that constitute grounds for
8324	imposing a moratorium and establish procedures for imposing and
8325	lifting a moratorium.
8326	Section 152.  Section 400.621, Florida Statutes, is amended
8327	to read:
8328	400.621  Rules and standards relating to adult family-care
8329	homes.--
8330	(1)  The agency department, in consultation with the
8331	Department of Health, the Department of Children and Family
8332	Services, and the department agency shall, by rule, establish
8333	minimum standards to ensure the health, safety, and well-being
8334	of each resident in the adult family-care home pursuant to this
8335	part and part II of chapter 408. The rules must address:
8336	(a)  Requirements for the physical site of the facility and
8337	facility maintenance.
8338	(b)  Services that must be provided to all residents of an
8339	adult family-care home and standards for such services, which
8340	must include, but need not be limited to:
8341	1.  Room and board.
8342	2.  Assistance necessary to perform the activities of daily
8343	living.
8344	3.  Assistance necessary to administer medication.
8345	4.  Supervision of residents.
8346	5.  Health monitoring.
8347	6.  Social and leisure activities.
8348	(c)  Standards and procedures for license application and
8349	annual license renewal, advertising, proper management of each
8350	resident's funds and personal property and personal affairs,
8351	financial ability to operate, medication management,
8352	inspections, complaint investigations, and facility, staff, and
8353	resident records.
8354	(d)  Qualifications, training, standards, and
8355	responsibilities for providers and staff.
8356	(e)  Compliance with chapter 419, relating to community
8357	residential homes.
8358	(f)  Criteria and procedures for determining the
8359	appropriateness of a resident's placement and continued
8360	residency in an adult family-care home. A resident who requires
8361	24-hour nursing supervision may not be retained in an adult
8362	family-care home unless such resident is an enrolled hospice
8363	patient and the resident's continued residency is mutually
8364	agreeable to the resident and the provider.
8365	(g)  Procedures for providing notice and assuring the least
8366	possible disruption of residents' lives when residents are
8367	relocated, an adult family-care home is closed, or the ownership
8368	of an adult family-care home is transferred.
8369	(h)  Procedures to protect the residents' rights as
8370	provided in s. 400.628.
8371	(i)  Procedures to promote the growth of adult family-care
8372	homes as a component of a long-term care system.
8373	(j)  Procedures to promote the goal of aging in place for
8374	residents of adult family-care homes.
8375	(2)  The agency department shall by rule provide minimum
8376	standards and procedures for emergencies. Pursuant to s.
8377	633.022, the State Fire Marshal, in consultation with the
8378	department and the agency, shall adopt uniform firesafety
8379	standards for adult family-care homes.
8380	(3)  The agency department shall adopt rules providing for
8381	the implementation of orders not to resuscitate. The provider
8382	may withhold or withdraw cardiopulmonary resuscitation if
8383	presented with an order not to resuscitate executed pursuant to
8384	s. 401.45. The provider shall not be subject to criminal
8385	prosecution or civil liability, nor be considered to have
8386	engaged in negligent or unprofessional conduct, for withholding
8387	or withdrawing cardiopulmonary resuscitation pursuant to such an
8388	order and applicable rules adopted by the department.
8389	(4)  The provider of any adult family-care home that is in
8390	operation at the time any rules are adopted or amended under
8391	this part may be given a reasonable time, not exceeding 6
8392	months, within which to comply with the new or revised rules and
8393	standards.
8394	Section 153.  Subsection (3) of section 400.6211, Florida
8395	Statutes, is amended to read:
8396	400.6211  Training and education programs.--
8397	(3)  Effective January 1, 2004, providers must complete the
8398	training and education program within a reasonable time
8399	determined by the agency department. Failure to complete the
8400	training and education program within the time set by the agency
8401	department is a violation of this part and subjects the provider
8402	to revocation of the license.
8403	Section 154.  Section 400.622, Florida Statutes, is
8404	repealed.
8405	Section 155.  Subsection (2) of section 400.625, Florida
8406	Statutes, is amended to read:
8407	400.625  Residency agreements.--
8408	(2)  Each residency agreement must specify the personal
8409	care and accommodations to be provided by the adult family-care
8410	home, the rates or charges, a requirement of at least 30 days'
8411	notice before a rate increase, and any other provisions required
8412	by rule of the agency department.
8413	Section 156.  Section 400.801, Florida Statutes, is amended
8414	to read:
8415	400.801  Homes for special services.--
8416	(1)  As used in this section, the term:
8417	(a)  "Agency" means the "Agency for Health Care
8418	Administration."
8419	(b)  "Home for special services" means a site where
8420	specialized health care services are provided, including
8421	personal and custodial care, but not continuous nursing
8422	services.
8423	(2)  The requirements of part II of chapter 408 shall apply
8424	to the provision of services that require licensure pursuant to
8425	this section and part II of chapter 408 and entities licensed by
8426	or applying for such licensure from the agency pursuant to this
8427	section. However, each applicant for licensure and each licensee
8428	is exempt from the provisions of s. 408.810(7)-(10). A person
8429	must obtain a license from the agency to operate a home for
8430	special services. A license is valid for 1 year.
8431	(3)  In accordance with s. 408.805, an applicant or
8432	licensee shall pay a fee for each license application submitted
8433	under this part, part II of chapter 408, and applicable rules.
8434	The amount of the fee shall be established by rule and shall not
8435	be more than $2,000 per biennium. The application for a license
8436	under this section must be made on a form provided by the
8437	agency. A nonrefundable license fee of not more than $1,000 must
8438	be submitted with the license application.
8439	(4)  Each applicant for licensure must comply with the
8440	following requirements:
8441	(a)  Upon receipt of a completed, signed, and dated
8442	application, the agency shall require background screening, in
8443	accordance with the level 2 standards for screening set forth in
8444	chapter 435, of the managing employee, or other similarly titled
8445	individual who is responsible for the daily operation of the
8446	facility, and of the financial officer, or other similarly
8447	titled individual who is responsible for the financial operation
8448	of the facility, including billings for client care and
8449	services, in accordance with the level 2 standards for screening
8450	set forth in chapter 435. The applicant must comply with the
8451	procedures for level 2 background screening as set forth in
8452	chapter 435.
8453	(b)  The agency may require background screening of any
8454	other individual who is an applicant if the agency has probable
8455	cause to believe that he or she has been convicted of a crime or
8456	has committed any other offense prohibited under the level 2
8457	standards for screening set forth in chapter 435.
8458	(c)  Proof of compliance with the level 2 background
8459	screening requirements of chapter 435 which has been submitted
8460	within the previous 5 years in compliance with any other health
8461	care or assisted living licensure requirements of this state is
8462	acceptable in fulfillment of the requirements of paragraph (a).
8463	(d)  A provisional license may be granted to an applicant
8464	when each individual required by this section to undergo
8465	background screening has met the standards for the Department of
8466	Law Enforcement background check, but the agency has not yet
8467	received background screening results from the Federal Bureau of
8468	Investigation, or a request for a disqualification exemption has
8469	been submitted to the agency as set forth in chapter 435, but a
8470	response has not yet been issued. A standard license may be
8471	granted to the applicant upon the agency's receipt of a report
8472	of the results of the Federal Bureau of Investigation background
8473	screening for each individual required by this section to
8474	undergo background screening which confirms that all standards
8475	have been met, or upon the granting of a disqualification
8476	exemption by the agency as set forth in chapter 435. Any other
8477	person who is required to undergo level 2 background screening
8478	may serve in his or her capacity pending the agency's receipt of
8479	the report from the Federal Bureau of Investigation. However,
8480	the person may not continue to serve if the report indicates any
8481	violation of background screening standards and a
8482	disqualification exemption has not been requested of and granted
8483	by the agency as set forth in chapter 435.
8484	(e)  Each applicant must submit to the agency, with its
8485	application, a description and explanation of any exclusions,
8486	permanent suspensions, or terminations of the applicant from the
8487	Medicare or Medicaid programs. Proof of compliance with the
8488	requirements for disclosure of ownership and control interests
8489	under the Medicaid or Medicare programs may be accepted in lieu
8490	of this submission.
8491	(f)  Each applicant must submit to the agency a description
8492	and explanation of any conviction of an offense prohibited under
8493	the level 2 standards of chapter 435 by a member of the board of
8494	directors of the applicant, its officers, or any individual
8495	owning 5 percent or more of the applicant. This requirement does
8496	not apply to a director of a not-for-profit corporation or
8497	organization if the director serves solely in a voluntary
8498	capacity for the corporation or organization, does not regularly
8499	take part in the day-to-day operational decisions of the
8500	corporation or organization, receives no remuneration for his or
8501	her services on the corporation or organization's board of
8502	directors, and has no financial interest and has no family
8503	members with a financial interest in the corporation or
8504	organization, provided that the director and the not-for-profit
8505	corporation or organization include in the application a
8506	statement affirming that the director's relationship to the
8507	corporation satisfies the requirements of this paragraph.
8508	(g)  A license may not be granted to an applicant if the
8509	applicant or managing employee has been found guilty of,
8510	regardless of adjudication, or has entered a plea of nolo
8511	contendere or guilty to, any offense prohibited under the level
8512	2 standards for screening set forth in chapter 435, unless an
8513	exemption from disqualification has been granted by the agency
8514	as set forth in chapter 435.
8515	(h)  The agency may deny or revoke licensure if the
8516	applicant:
8517	1.  Has falsely represented a material fact in the
8518	application required by paragraph (e) or paragraph (f), or has
8519	omitted any material fact from the application required by
8520	paragraph (e) or paragraph (f); or
8521	2.  Has had prior action taken against the applicant under
8522	the Medicaid or Medicare program as set forth in paragraph (e).
8523	(i)  An application for license renewal must contain the
8524	information required under paragraphs (e) and (f).
8525	(5)  Application for license renewal must be submitted 90
8526	days before the expiration of the license.
8527	(6)  A change of ownership or control of a home for special
8528	services must be reported to the agency in writing at least 60
8529	days before the change is scheduled to take effect.
8530	(4)(7)  The agency may shall adopt rules for implementing
8531	and enforcing this section and part II of chapter 408.
8532	(8)(a)  It is unlawful for any person to establish,
8533	conduct, manage, or operate a home for special services without
8534	obtaining a license from the agency.
8535	(b)  It is unlawful for any person to offer or advertise to
8536	the public, in any medium whatever, specialized health care
8537	services without obtaining a license from the agency.
8538	(c)  It is unlawful for a holder of a license issued under
8539	this section to advertise or represent to the public that it
8540	holds a license for a type of facility other than the facility
8541	for which its license is issued.
8542	(5)(9)(a)  In accordance with part II of chapter 408, a
8543	violation of any provision of this section, part II of chapter
8544	408, or applicable rules adopted by the agency for implementing
8545	this section is punishable by payment of an administrative fine
8546	not to exceed $5,000.
8547	(b)  A violation of subsection (8) or rules adopted under
8548	that subsection is a misdemeanor of the first degree, punishable
8549	as provided in s. 775.082 or s. 775.083. Each day of continuing
8550	violation is a separate offense.
8551	Section 157.  Section 400.805, Florida Statutes, is amended
8552	to read:
8553	400.805  Transitional living facilities.--
8554	(1)  As used in this section, the term:
8555	(a)  "Agency" means the Agency for Health Care
8556	Administration.
8557	(b)  "Department" means the Department of Health.
8558	(c)  "Transitional living facility" means a site where
8559	specialized health care services are provided, including, but
8560	not limited to, rehabilitative services, community reentry
8561	training, aids for independent living, and counseling to spinal-
8562	cord-injured persons and head-injured persons. This term does
8563	not include a hospital licensed under chapter 395 or any
8564	federally operated hospital or facility.
8565	(2)(a)  The requirements of part II of chapter 408 shall
8566	apply to the provision of services that require licensure
8567	pursuant to this section and part II of chapter 408 and to
8568	entities licensed by or applying for such licensure from the
8569	agency pursuant to this section. However, each applicant for
8570	licensure and each licensee is exempt from the provisions of s.
8571	408.810(7)-(10). A person must obtain a license from the agency
8572	to operate a transitional living facility. A license issued
8573	under this section is valid for 1 year.
8574	(b)  In accordance with this section, an applicant or a
8575	licensee shall pay a fee for each license application submitted
8576	under this part, part II of chapter 408, and applicable rules.
8577	The fee shall consist of a $4,000 license fee and a $78.50 per
8578	bed fee per biennium, unless modified by rule. The application
8579	for a license must be made on a form provided by the agency. A
8580	nonrefundable license fee of $2,000 and a fee of up to $39.25
8581	per bed must be submitted with the license application.
8582	(c)  The agency may not issue a license to an applicant
8583	until the agency receives notice from the department as provided
8584	in paragraph (3)(6)(b).
8585	(3)  Each applicant for licensure must comply with the
8586	following requirements:
8587	(a)  Upon receipt of a completed, signed, and dated
8588	application, the agency shall require background screening, in
8589	accordance with the level 2 standards for screening set forth in
8590	chapter 435, of the managing employee, or other similarly titled
8591	individual who is responsible for the daily operation of the
8592	facility, and of the financial officer, or other similarly
8593	titled individual who is responsible for the financial operation
8594	of the facility, including billings for client care and
8595	services. The applicant must comply with the procedures for
8596	level 2 background screening as set forth in chapter 435.
8597	(b)  The agency may require background screening of any
8598	other individual who is an applicant if the agency has probable
8599	cause to believe that he or she has been convicted of a crime or
8600	has committed any other offense prohibited under the level 2
8601	standards for screening set forth in chapter 435.
8602	(c)  Proof of compliance with the level 2 background
8603	screening requirements of chapter 435 which has been submitted
8604	within the previous 5 years in compliance with any other health
8605	care or assisted living licensure requirements of this state is
8606	acceptable in fulfillment of the requirements of paragraph (a).
8607	(d)  A provisional license may be granted to an applicant
8608	when each individual required by this section to undergo
8609	background screening has met the standards for the Department of
8610	Law Enforcement background check, but the agency has not yet
8611	received background screening results from the Federal Bureau of
8612	Investigation, or a request for a disqualification exemption has
8613	been submitted to the agency as set forth in chapter 435, but a
8614	response has not yet been issued. A standard license may be
8615	granted to the applicant upon the agency's receipt of a report
8616	of the results of the Federal Bureau of Investigation background
8617	screening for each individual required by this section to
8618	undergo background screening which confirms that all standards
8619	have been met, or upon the granting of a disqualification
8620	exemption by the agency as set forth in chapter 435. Any other
8621	person who is required to undergo level 2 background screening
8622	may serve in his or her capacity pending the agency's receipt of
8623	the report from the Federal Bureau of Investigation. However,
8624	the person may not continue to serve if the report indicates any
8625	violation of background screening standards and a
8626	disqualification exemption has not been requested of and granted
8627	by the agency as set forth in chapter 435.
8628	(e)  Each applicant must submit to the agency, with its
8629	application, a description and explanation of any exclusions,
8630	permanent suspensions, or terminations of the applicant from the
8631	Medicare or Medicaid programs. Proof of compliance with the
8632	requirements for disclosure of ownership and control interests
8633	under the Medicaid or Medicare programs may be accepted in lieu
8634	of this submission.
8635	(f)  Each applicant must submit to the agency a description
8636	and explanation of any conviction of an offense prohibited under
8637	the level 2 standards of chapter 435 by a member of the board of
8638	directors of the applicant, its officers, or any individual
8639	owning 5 percent or more of the applicant. This requirement does
8640	not apply to a director of a not-for-profit corporation or
8641	organization if the director serves solely in a voluntary
8642	capacity for the corporation or organization, does not regularly
8643	take part in the day-to-day operational decisions of the
8644	corporation or organization, receives no remuneration for his or
8645	her services on the corporation or organization's board of
8646	directors, and has no financial interest and has no family
8647	members with a financial interest in the corporation or
8648	organization, provided that the director and the not-for-profit
8649	corporation or organization include in the application a
8650	statement affirming that the director's relationship to the
8651	corporation satisfies the requirements of this paragraph.
8652	(g)  A license may not be granted to an applicant if the
8653	applicant or managing employee has been found guilty of,
8654	regardless of adjudication, or has entered a plea of nolo
8655	contendere or guilty to, any offense prohibited under the level
8656	2 standards for screening set forth in chapter 435, unless an
8657	exemption from disqualification has been granted by the agency
8658	as set forth in chapter 435.
8659	(h)  The agency may deny or revoke licensure if the
8660	applicant:
8661	1.  Has falsely represented a material fact in the
8662	application required by paragraph (e) or paragraph (f), or has
8663	omitted any material fact from the application required by
8664	paragraph (e) or paragraph (f); or
8665	2.  Has had prior action taken against the applicant under
8666	the Medicaid or Medicare program as set forth in paragraph (e).
8667	(i)  An application for license renewal must contain the
8668	information required under paragraphs (e) and (f).
8669	(4)  An application for renewal of license must be
8670	submitted 90 days before the expiration of the license. Upon
8671	renewal of licensure, each applicant must submit to the agency,
8672	under penalty of perjury, an affidavit as set forth in paragraph
8673	(3)(d).
8674	(5)  A change of ownership or control of a transitional
8675	living facility must be reported to the agency in writing at
8676	least 60 days before the change is scheduled to take effect.
8677	(3)(6)(a)  The agency shall adopt rules in consultation
8678	with the department governing the physical plant of transitional
8679	living facilities and the fiscal management of transitional
8680	living facilities.
8681	(b)  The department shall adopt rules in consultation with
8682	the agency governing the services provided to clients of
8683	transitional living facilities. The department shall enforce all
8684	requirements for providing services to the facility's clients.
8685	The department must notify the agency when it determines that an
8686	applicant for licensure meets the service requirements adopted
8687	by the department.
8688	(c)  The agency and the department shall enforce
8689	requirements under this section, as such requirements relate to
8690	them respectively, and their respective adopted rules.
8691	(7)(a)  It is unlawful for any person to establish,
8692	conduct, manage, or operate a transitional living facility
8693	without obtaining a license from the agency.
8694	(b)  It is unlawful for any person to offer or advertise to
8695	the public, in any medium whatever, services or care defined in
8696	paragraph (1)(c) without obtaining a license from the agency.
8697	(c)  It is unlawful for a holder of a license issued under
8698	this section to advertise or represent to the public that it
8699	holds a license for a type of facility other than the facility
8700	for which its license is issued.
8701	(4)(8)  Any designated officer or employee of the agency,
8702	of the state, or of the local fire marshal may enter unannounced
8703	upon and into the premises of any facility licensed under this
8704	section in order to determine the state of compliance with this
8705	section and the rules or standards in force under this section.
8706	The right of entry and inspection also extends to any premises
8707	that the agency has reason to believe are being operated or
8708	maintained as a facility without a license; but such an entry or
8709	inspection may not be made without the permission of the owner
8710	or person in charge of the facility unless a warrant that
8711	authorizes the entry is first obtained from the circuit court.
8712	The warrant requirement extends only to a facility that the
8713	agency has reason to believe is being operated or maintained as
8714	a facility without a license. An application for a license or
8715	renewal thereof which is made under this section constitutes
8716	permission for, and acquiescence in, any entry or inspection of
8717	the premises for which the license is sought, in order to
8718	facilitate verification of the information submitted on or in
8719	connection with the application; to discover, investigate, and
8720	determine the existence of abuse or neglect; or to elicit,
8721	receive, respond to, and resolve complaints. A current valid
8722	license constitutes unconditional permission for, and
8723	acquiescence in, any entry or inspection of the premises by
8724	authorized personnel. The agency retains the right of entry and
8725	inspection of facilities that have had a license revoked or
8726	suspended within the previous 24 months, to ensure that the
8727	facility is not operating unlawfully. However, before the
8728	facility is entered, a statement of probable cause must be filed
8729	with the director of the agency, who must approve or disapprove
8730	the action within 48 hours. Probable cause includes, but is not
8731	limited to, evidence that the facility holds itself out to the
8732	public as a provider of personal assistance services, or the
8733	receipt by the advisory council on brain and spinal cord
8734	injuries of a complaint about the facility.
8735	(5)(9)  The agency may institute injunctive proceedings in
8736	a court of competent jurisdiction for temporary or permanent
8737	relief to:
8738	(a)  Enforce this section or any minimum standard, rule, or
8739	order issued pursuant thereto if the agency's effort to correct
8740	a violation through administrative fines has failed or when the
8741	violation materially affects the health, safety, or welfare of
8742	residents; or
8743	(b)  Terminate the operation of a facility if a violation
8744	of this section or of any standard or rule adopted pursuant
8745	thereto exists which materially affects the health, safety, or
8746	welfare of residents.
8747
8748	The Legislature recognizes that, in some instances, action is
8749	necessary to protect residents of facilities from immediately
8750	life-threatening situations. If it appears by competent evidence
8751	or a sworn, substantiated affidavit that a temporary injunction
8752	should issue, the court, pending the determination on final
8753	hearing, shall enjoin operation of the facility.
8754	(10)  The agency may impose an immediate moratorium on
8755	admissions to a facility when the agency determines that any
8756	condition in the facility presents a threat to the health,
8757	safety, or welfare of the residents in the facility. If a
8758	facility's license is denied, revoked, or suspended, the
8759	facility may be subject to the immediate imposition of a
8760	moratorium on admissions to run concurrently with licensure
8761	denial, revocation, or suspension.
8762	(6)(11)(a)  In accordance with part II of chapter 408, a
8763	violation of any provision of this section, part II of chapter
8764	408, or applicable rules adopted by the agency or department
8765	under this section is punishable by payment of an administrative
8766	or a civil penalty fine not to exceed $5,000.
8767	(b)  A violation of subsection (7) or rules adopted under
8768	that subsection is a misdemeanor of the first degree, punishable
8769	as provided in s. 775.082 or s. 775.083. Each day of a
8770	continuing violation is a separate offense.
8771	Section 158.  Subsection (4) of section 400.902, Florida
8772	Statutes, is amended to read:
8773	400.902  Definitions.--As used in this part, the term:
8774	(4)  "Owner or operator" means a licensee any individual
8775	who has general administrative charge of a PPEC center.
8776	Section 159.  Subsection (3) is added to section 400.903,
8777	Florida Statutes, to read:
8778	400.903  PPEC centers to be licensed; exemptions.--
8779	(3)  The requirements of part II of chapter 408 shall apply
8780	to the provision of services that require licensure pursuant to
8781	this part and part II of chapter 408 and to entities licensed by
8782	or applying for such licensure from the agency pursuant to this
8783	part. However, each applicant for licensure and each licensee is
8784	exempt from the provisions of s. 408.810(10).
8785	Section 160.  Section 400.905, Florida Statutes, is amended
8786	to read:
8787	400.905  License required; fee; exemption; display.--
8788	(1)(a)  It is unlawful to operate or maintain a PPEC center
8789	without first obtaining from the agency a license authorizing
8790	such operation. The agency is responsible for licensing PPEC
8791	centers in accordance with the provisions of this part.
8792	(b)  Any person who violates paragraph (a) is guilty of a
8793	felony of the third degree, punishable as provided in s.
8794	775.082, s. 775.083, or s. 775.084.
8795	(1)(2)  Separate licenses are required for PPEC centers
8796	maintained on separate premises, even though they are operated
8797	under the same management. Separate licenses are not required
8798	for separate buildings on the same grounds.
8799	(2)(3)  In accordance with s. 408.805, an applicant or
8800	licensee shall pay a fee for each license application submitted
8801	under this part, part II of chapter 408, and applicable rules.
8802	The amount of the fee shall be established by rule and shall not
8803	be less than $1,000 or more than $3,000 per biennium. The annual
8804	license fee required of a PPEC center shall be in an amount
8805	determined by the agency to be sufficient to cover the agency's
8806	costs in carrying out its responsibilities under this part, but
8807	shall not be less than $500 or more than $1,500.
8808	(3)(4)  County-operated or municipally operated PPEC
8809	centers applying for licensure under this part are exempt from
8810	the payment of license fees.
8811	(5)  The license shall be displayed in a conspicuous place
8812	inside the PPEC center.
8813	(6)  A license shall be valid only in the possession of the
8814	individual, firm, partnership, association, or corporation to
8815	whom it is issued and shall not be subject to sale, assignment,
8816	or other transfer, voluntary or involuntary; nor shall a license
8817	be valid for any premises other than that for which originally
8818	issued.
8819	(7)  Any license granted by the agency shall state the
8820	maximum capacity of the facility, the date the license was
8821	issued, the expiration date of the license, and any other
8822	information deemed necessary by the agency.
8823	Section 161.  Section 400.906, Florida Statutes, is
8824	repealed.
8825	Section 162.  Section 400.907, Florida Statutes, is amended
8826	to read:
8827	400.907  Denial, suspension, revocation of licensure;
8828	administrative fines; grounds.--
8829	(1)  In accordance with part II of chapter 408, the agency
8830	may deny, revoke, and or suspend a license and or impose an
8831	administrative fine for the violation of any provision of this
8832	part, part II of chapter 408, or applicable rules in the manner
8833	provided in chapter 120.
8834	(2)  Any of the following actions by a PPEC center or its
8835	employee is grounds for action by the agency against a PPEC
8836	center or its employee:
8837	(a)  An intentional or negligent act materially affecting
8838	the health or safety of children in the PPEC center.
8839	(b)  A violation of the provisions of this part, part II of
8840	chapter 408, or applicable rules or of any standards or rules
8841	adopted pursuant to this part.
8842	(c)  Multiple and repeated violations of this part or of
8843	minimum standards or rules adopted pursuant to this part.
8844	(3)  The agency shall be responsible for all investigations
8845	and inspections conducted pursuant to this part.
8846	Section 163.  Section 400.908, Florida Statutes, is amended
8847	to read:
8848	400.908  Administrative fines; disposition of fees and
8849	fines.--
8850	(1)(a)  If the agency determines that a PPEC center is
8851	being operated without a license or is otherwise not in
8852	compliance with rules adopted under this part, part II of
8853	chapter 408, or applicable rules, the agency, notwithstanding
8854	any other administrative action it takes, shall make a
8855	reasonable attempt to discuss each violation and recommended
8856	corrective action with the owner of the PPEC center prior to
8857	written notification thereof. The agency may request that the
8858	PPEC center submit a corrective action plan which demonstrates a
8859	good faith effort to remedy each violation by a specific date,
8860	subject to the approval of the agency.
8861	(b)  In accordance with part II of chapter 408, the agency
8862	may fine a PPEC center or employee found in violation of rules
8863	adopted pursuant to this part, part II of chapter 408, or
8864	applicable rules, in an amount not to exceed $500 for each
8865	violation. Such fine may not exceed $5,000 in the aggregate.
8866	(c)  The failure to correct a violation by the date set by
8867	the agency, or the failure to comply with an approved corrective
8868	action plan, is a separate violation for each day such failure
8869	continues, unless the agency approves an extension to a specific
8870	date.
8871	(d)  If a PPEC center desires to appeal any agency action
8872	under this section and the fine is upheld, the violator shall
8873	pay the fine, plus interest at the legal rate specified in s.
8874	687.01, for each day beyond the date set by the agency for
8875	payment of the fine.
8876	(2)  In determining if a fine is to be imposed and in
8877	fixing the amount of any fine, the agency shall consider the
8878	following factors:
8879	(a)  The gravity of the violation, including the
8880	probability that death or serious physical or emotional harm to
8881	a child will result or has resulted, the severity of the actual
8882	or potential harm, and the extent to which the provisions of the
8883	applicable statutes or rules were violated.
8884	(b)  Actions taken by the owner or operator to correct
8885	violations.
8886	(c)  Any previous violations.
8887	(d)  The financial benefit to the PPEC center of committing
8888	or continuing the violation.
8889	(3)  Fees and fines received by the agency under this part
8890	shall be deposited in the Health Care Trust Fund created in s.
8891	408.16.
8892	Section 164.  Section 400.910, Florida Statutes, is
8893	repealed.
8894	Section 165.  Section 400.911, Florida Statutes, is
8895	repealed.
8896	Section 166.  Section 400.912, Florida Statutes, is amended
8897	to read:
8898	400.912  Closing of a PPEC center.--
8899	(1)  Whenever a PPEC center voluntarily discontinues
8900	operation, it shall, inform the agency in writing at least 30
8901	days before the discontinuance of operation. The PPEC center
8902	shall also, at such time, inform each child's legal guardian of
8903	the fact and the proposed time of such discontinuance.
8904	(2)  Immediately upon discontinuance of the operation of a
8905	PPEC center, the owner or operator shall surrender the license
8906	therefor to the agency and the license shall be canceled.
8907	Section 167.  Section 400.913, Florida Statutes, is
8908	repealed.
8909	Section 168.  Subsection (1) of section 400.914, Florida
8910	Statutes, is amended to read:
8911	400.914  Rules establishing standards.--
8912	(1)  Pursuant to the intention of the Legislature to
8913	provide safe and sanitary facilities and healthful programs, the
8914	agency in conjunction with the Division of Children's Medical
8915	Services Prevention and Intervention of the Department of Health
8916	shall adopt and publish rules to implement the provisions of
8917	this part and part II of chapter 408, which shall include
8918	reasonable and fair standards. Any conflict between these
8919	standards and those that may be set forth in local, county, or
8920	city ordinances shall be resolved in favor of those having
8921	statewide effect. Such standards shall relate to:
8922	(a)  The assurance that PPEC services are family centered
8923	and provide individualized medical, developmental, and family
8924	training services.
8925	(b)  The maintenance of PPEC centers, not in conflict with
8926	the provisions of chapter 553 and based upon the size of the
8927	structure and number of children, relating to plumbing, heating,
8928	lighting, ventilation, and other building conditions, including
8929	adequate space, which will ensure the health, safety, comfort,
8930	and protection from fire of the children served.
8931	(c)  The appropriate provisions of the most recent edition
8932	of the "Life Safety Code" (NFPA-101) shall be applied.
8933	(d)  The number and qualifications of all personnel who
8934	have responsibility for the care of the children served.
8935	(e)  All sanitary conditions within the PPEC center and its
8936	surroundings, including water supply, sewage disposal, food
8937	handling, and general hygiene, and maintenance thereof, which
8938	will ensure the health and comfort of children served.
8939	(f)  Programs and basic services promoting and maintaining
8940	the health and development of the children served and meeting
8941	the training needs of the children's legal guardians.
8942	(g)  Supportive, contracted, other operational, and
8943	transportation services.
8944	(h)  Maintenance of appropriate medical records, data, and
8945	information relative to the children and programs. Such records
8946	shall be maintained in the facility for inspection by the
8947	agency.
8948	Section 169.  Subsection (3) of section 400.915, Florida
8949	Statutes, is amended to read:
8950	400.915  Construction and renovation; requirements.--The
8951	requirements for the construction or renovation of a PPEC center
8952	shall comply with:
8953	(3)  The standards or rules adopted pursuant to this part
8954	and part II of chapter 408.
8955	Section 170.  Section 400.916, Florida Statutes, is
8956	repealed.
8957	Section 171.  Section 400.917, Florida Statutes, is
8958	repealed.
8959	Section 172.  Section 400.925, Florida Statutes, is amended
8960	to read:
8961	400.925  Definitions.--As used in this part, the term:
8962	(1)  "Accrediting organizations" means the Joint Commission
8963	on Accreditation of Healthcare Organizations or other national
8964	accreditation agencies whose standards for accreditation are
8965	comparable to those required by this part for licensure.
8966	(2)  "Affiliated person" means any person who directly or
8967	indirectly manages, controls, or oversees the operation of a
8968	corporation or other business entity that is a licensee,
8969	regardless of whether such person is a partner, shareholder,
8970	owner, officer, director, agent, or employee of the entity.
8971	(2)(3)  "Agency" means the Agency for Health Care
8972	Administration.
8973	(4)  "Applicant" means an individual applicant in the case
8974	of a sole proprietorship, or any officer, director, agent,
8975	managing employee, general manager, or affiliated person, or any
8976	partner or shareholder having an ownership interest equal to 5
8977	percent or greater in the corporation, partnership, or other
8978	business entity.
8979	(3)(5)  "Consumer" or "patient" means any person who uses
8980	home medical equipment in his or her place of residence.
8981	(4)(6)  "Department" means the Department of Children and
8982	Family Services.
8983	(5)(7)  "General manager" means the individual who has the
8984	general administrative charge of the premises of a licensed home
8985	medical equipment provider.
8986	(6)(8)  "Home medical equipment" includes any product as
8987	defined by the Federal Drug Administration's Drugs, Devices and
8988	Cosmetics Act, any products reimbursed under the Medicare Part B
8989	Durable Medical Equipment benefits, or any products reimbursed
8990	under the Florida Medicaid durable medical equipment program.
8991	Home medical equipment includes oxygen and related respiratory
8992	equipment; manual, motorized, or customized wheelchairs and
8993	related seating and positioning, but does not include
8994	prosthetics or orthotics or any splints, braces, or aids custom
8995	fabricated by a licensed health care practitioner; motorized
8996	scooters; personal transfer systems; and specialty beds, for use
8997	by a person with a medical need.
8998	(7)(9)  "Home medical equipment provider" means any person
8999	or entity that sells or rents or offers to sell or rent to or
9000	for a consumer:
9001	(a)  Any home medical equipment and services; or
9002	(b)  Home medical equipment that requires any home medical
9003	equipment services.
9004	(8)(10)  "Home medical equipment provider personnel" means
9005	persons who are employed by or under contract with a home
9006	medical equipment provider.
9007	(9)(11)  "Home medical equipment services" means equipment
9008	management and consumer instruction, including selection,
9009	delivery, setup, and maintenance of equipment, and other related
9010	services for the use of home medical equipment in the consumer's
9011	regular or temporary place of residence.
9012	(10)(12)  "Licensee" means the person or entity to whom a
9013	license to operate as a home medical equipment provider is
9014	issued by the agency.
9015	(11)(13)  "Moratorium" has the same meaning as in s.
9016	408.803, except that means a mandated temporary cessation or
9017	suspension of the sale, rental, or offering of equipment after
9018	the imposition of the moratorium. services related to equipment
9019	sold or rented prior to the moratorium must be continued without
9020	interruption, unless deemed otherwise by the agency.
9021	(12)(14)  "Person" means any individual, firm, partnership,
9022	corporation, or association.
9023	(13)(15)  "Premises" means those buildings and equipment
9024	which are located at the address of the licensed home medical
9025	equipment provider for the provision of home medical equipment
9026	services, which are in such reasonable proximity as to appear to
9027	the public to be a single provider location, and which comply
9028	with zoning ordinances.
9029	(14)(16)  "Residence" means the consumer's home or place of
9030	residence, which may include nursing homes, assisted living
9031	facilities, transitional living facilities, adult family-care
9032	homes, or other congregate residential facilities.
9033	Section 173.  Subsection (3) and paragraphs (b), (d), and
9034	(e) of subsection (6) of section 400.93, Florida Statutes, are
9035	amended to read:
9036	400.93  Licensure required; exemptions; unlawful acts;
9037	penalties.--
9038	(3)  The requirements of part II of chapter 408 shall apply
9039	to the provision of services that require licensure pursuant to
9040	this part and part II of chapter 408 and to entities licensed by
9041	or applying for such licensure from the agency pursuant to this
9042	part. However, each applicant for licensure and each licensee is
9043	exempt from the provisions of s. 408.810(10). A home medical
9044	equipment provider must be licensed by the agency to operate in
9045	this state or to provide home medical equipment and services to
9046	consumers in this state. A standard license issued to a home
9047	medical equipment provider, unless sooner suspended or revoked,
9048	expires 2 years after its effective date.
9049	(6)
9050	(b)  A person who violates paragraph (a) is subject to an
9051	injunctive proceeding under this part, part II of chapter 408,
9052	or applicable rules s. 400.956. A violation of paragraph (a) is
9053	a deceptive and unfair trade practice and constitutes a
9054	violation of the Florida Deceptive and Unfair Trade Practices
9055	Act.
9056	(d)  The following penalties shall be imposed for operating
9057	an unlicensed home medical equipment provider:
9058	1.  Any person or entity who operates an unlicensed
9059	provider commits a felony of the third degree.
9060	2.  For any person or entity who has received government
9061	reimbursement for services provided by an unlicensed provider,
9062	the agency shall make a fraud referral to the appropriate
9063	government reimbursement program.
9064	3.  For any licensee found to be concurrently operating
9065	licensed and unlicensed provider premises, the agency may impose
9066	a fine or moratorium, or revoke existing licenses of any or all
9067	of the licensee's licensed provider locations until such time as
9068	the unlicensed provider premises is licensed.
9069	(e)  A provider found to be operating without a license may
9070	apply for licensure, and must cease operations until a license
9071	is awarded by the agency.
9072	Section 174.  Section 400.931, Florida Statutes, is amended
9073	to read:
9074	400.931  Application for license; fee; provisional license;
9075	temporary permit.--
9076	(1)  Application for an initial license or for renewal of
9077	an existing license must be made under oath to the agency on
9078	forms furnished by it and must be accompanied by the appropriate
9079	license fee as provided in subsection (12).
9080	(1)(2)  The applicant must file with the application
9081	satisfactory proof that the home medical equipment provider is
9082	in compliance with this part and applicable rules, including:
9083	(a)  A report, by category, of the equipment to be
9084	provided, indicating those offered either directly by the
9085	applicant or through contractual arrangements with existing
9086	providers. Categories of equipment include:
9087	1.  Respiratory modalities.
9088	2.  Ambulation aids.
9089	3.  Mobility aids.
9090	4.  Sickroom setup.
9091	5.  Disposables.
9092	(b)  A report, by category, of the services to be provided,
9093	indicating those offered either directly by the applicant or
9094	through contractual arrangements with existing providers.
9095	Categories of services include:
9096	1.  Intake.
9097	2.  Equipment selection.
9098	3.  Delivery.
9099	4.  Setup and installation.
9100	5.  Patient training.
9101	6.  Ongoing service and maintenance.
9102	7.  Retrieval.
9103	(c)  A listing of those with whom the applicant contracts,
9104	both the providers the applicant uses to provide equipment or
9105	services to its consumers and the providers for whom the
9106	applicant provides services or equipment.
9107	(2)(3)  As an alternative to submitting proof of financial
9108	ability to operate as required in s. 408.810(8) The applicant
9109	for initial licensure must demonstrate financial ability to
9110	operate, the applicant may submit which may be accomplished by
9111	the submission of a $50,000 surety bond to the agency.
9112	(4)  An applicant for renewal who has demonstrated
9113	financial inability to operate must demonstrate financial
9114	ability to operate.
9115	(5)  Each applicant for licensure must comply with the
9116	following requirements:
9117	(a)  Upon receipt of a completed, signed, and dated
9118	application, the agency shall require background screening of
9119	the applicant, in accordance with the level 2 standards for
9120	screening set forth in chapter 435. As used in this subsection,
9121	the term "applicant" means the general manager and the financial
9122	officer or similarly titled individual who is responsible for
9123	the financial operation of the licensed facility.
9124	(b)  The agency may require background screening for a
9125	member of the board of directors of the licensee or an officer
9126	or an individual owning 5 percent or more of the licensee if the
9127	agency has probable cause to believe that such individual has
9128	been convicted of an offense prohibited under the level 2
9129	standards for screening set forth in chapter 435.
9130	(c)  Proof of compliance with the level 2 background
9131	screening requirements of chapter 435 which has been submitted
9132	within the previous 5 years in compliance with any other health
9133	care licensure requirements of this state is acceptable in
9134	fulfillment of paragraph (a).
9135	(d)  Each applicant must submit to the agency, with its
9136	application, a description and explanation of any exclusions,
9137	permanent suspensions, or terminations of the applicant from the
9138	Medicare or Medicaid programs. Proof of compliance with
9139	disclosure of ownership and control interest requirements of the
9140	Medicaid or Medicare programs shall be accepted in lieu of this
9141	submission.
9142	(e)  Each applicant must submit to the agency a description
9143	and explanation of any conviction of an offense prohibited under
9144	the level 2 standards of chapter 435 by a member of the board of
9145	directors of the applicant, its officers, or any individual
9146	owning 5 percent or more of the applicant. This requirement does
9147	not apply to a director of a not-for-profit corporation or
9148	organization if the director serves solely in a voluntary
9149	capacity for the corporation or organization, does not regularly
9150	take part in the day-to-day operational decisions of the
9151	corporation or organization, receives no remuneration for his or
9152	her services on the corporation's or organization's board of
9153	directors, and has no financial interest and has no family
9154	members with a financial interest in the corporation or
9155	organization, provided that the director and the not-for-profit
9156	corporation or organization include in the application a
9157	statement affirming that the director's relationship to the
9158	corporation satisfies the requirements of this provision.
9159	(f)  A license may not be granted to any potential licensee
9160	if any applicant, administrator, or financial officer has been
9161	found guilty of, regardless of adjudication, or has entered a
9162	plea of nolo contendere or guilty to, any offense prohibited
9163	under the level 2 standards for screening set forth in chapter
9164	435, unless an exemption from disqualification has been granted
9165	by the agency as set forth in chapter 435.
9166	(g)  The agency may deny or revoke licensure to any
9167	potential licensee if any applicant:
9168	1.  Has falsely represented a material fact in the
9169	application required by paragraphs (d) and (e), or has omitted
9170	any material fact from the application required by paragraphs
9171	(d) and (e); or
9172	2.  Has had prior Medicaid or Medicare action taken against
9173	the applicant as set forth in paragraph (d).
9174	(h)  Upon licensure renewal, each applicant must submit to
9175	the agency, under penalty of perjury, an affidavit of compliance
9176	with the background screening provisions of this section.
9177	(3)(6)  As specified in part II of chapter 408, the home
9178	medical equipment provider must also obtain and maintain
9179	professional and commercial liability insurance. Proof of
9180	liability insurance, as defined in s. 624.605, must be submitted
9181	with the application. The agency shall set the required amounts
9182	of liability insurance by rule, but the required amount must not
9183	be less than $250,000 per claim. In the case of contracted
9184	services, it is required that the contractor have liability
9185	insurance not less than $250,000 per claim.
9186	(7)  A provisional license shall be issued to an approved
9187	applicant for initial licensure for a period of 90 days, during
9188	which time a survey must be conducted demonstrating substantial
9189	compliance with this section. A provisional license shall also
9190	be issued pending the results of an applicant's Federal Bureau
9191	of Investigation report of background screening confirming that
9192	all standards have been met. If substantial compliance is
9193	demonstrated, a standard license shall be issued to expire 2
9194	years after the effective date of the provisional license.
9195	(8)  Ninety days before the expiration date, an application
9196	for license renewal must be submitted to the agency under oath
9197	on forms furnished by the agency, and a license shall be renewed
9198	if the applicant has met the requirements established under this
9199	part and applicable rules. The home medical equipment provider
9200	must file with the application satisfactory proof that it is in
9201	compliance with this part and applicable rules. The home medical
9202	equipment provider must submit satisfactory proof of its
9203	financial ability to comply with the requirements of this part.
9204	(9)  When a change of ownership of a home medical equipment
9205	provider occurs, the prospective owner must submit an initial
9206	application for a license at least 15 days before the effective
9207	date of the change of ownership. An application for change of
9208	ownership of a license is required when ownership, a majority of
9209	the ownership, or controlling interest of a licensed home
9210	medical equipment provider is transferred or assigned and when a
9211	licensee agrees to undertake or provide services to the extent
9212	that legal liability for operation of the home medical equipment
9213	provider rests with the licensee. A provisional license shall be
9214	issued to the new owner for a period of 90 days, during which
9215	time all required documentation must be submitted and a survey
9216	must be conducted demonstrating substantial compliance with this
9217	section. If substantial compliance is demonstrated, a standard
9218	license shall be issued to expire 2 years after the issuance of
9219	the provisional license.
9220	(4)(10)  When a change of the general manager of a home
9221	medical equipment provider occurs, the licensee must notify the
9222	agency of the change within 45 days. thereof and must provide
9223	evidence of compliance with the background screening
9224	requirements in subsection (5); except that a general manager
9225	who has met the standards for the Department of Law Enforcement
9226	background check, but for whom background screening results from
9227	the Federal Bureau of Investigation have not yet been received,
9228	may be employed pending receipt of the Federal Bureau of
9229	Investigation background screening report. An individual may not
9230	continue to serve as general manager if the Federal Bureau of
9231	Investigation background screening report indicates any
9232	violation of background screening standards.
9233	(5)(11)  In accordance with s. 408.805, an applicant or a
9234	licensee shall pay a fee for each license application submitted
9235	under this part, part II of chapter 408, and applicable rules.
9236	The amount of the fee shall be established by rule and shall not
9237	exceed $300 per biennium. All licensure fees required of a home
9238	medical equipment provider are nonrefundable. The agency shall
9239	set the fees in an amount that is sufficient to cover its costs
9240	in carrying out its responsibilities under this part. However,
9241	state, county, or municipal governments applying for licenses
9242	under this part are exempt from the payment of license fees. All
9243	fees collected under this part must be deposited in the Health
9244	Care Trust Fund for the administration of this part.
9245	(6)(12)  An applicant for initial licensure, renewal, or
9246	change of ownership shall also pay a license processing fee not
9247	to exceed $300, to be paid by all applicants, and an inspection
9248	fee not to exceed $400, which shall to be paid by all applicants
9249	except those not subject to licensure inspection by the agency
9250	as described in s. 400.933(2).
9251	(13)  When a change is reported which requires issuance of
9252	a license, a fee must be assessed. The fee must be based on the
9253	actual cost of processing and issuing the license.
9254	(14)  When a duplicate license is issued, a fee must be
9255	assessed, not to exceed the actual cost of duplicating and
9256	mailing.
9257	(15)  When applications are mailed out upon request, a fee
9258	must be assessed, not to exceed the cost of the printing,
9259	preparation, and mailing.
9260	(16)  The license must be displayed in a conspicuous place
9261	in the administrative office of the home medical equipment
9262	provider and is valid only while in the possession of the person
9263	or entity to which it is issued. The license may not be sold,
9264	assigned, or otherwise transferred, voluntarily or
9265	involuntarily, and is valid only for the home medical equipment
9266	provider and location for which originally issued.
9267	(17)  A home medical equipment provider against whom a
9268	proceeding for revocation or suspension, or for denial of a
9269	renewal application, is pending at the time of license renewal
9270	may be issued a provisional license effective until final
9271	disposition by the agency of such proceedings. If judicial
9272	relief is sought from the final disposition, the court that has
9273	jurisdiction may issue a temporary permit for the duration of
9274	the judicial proceeding.
9275	Section 175.  Section 400.932, Florida Statutes, is amended
9276	to read:
9277	400.932  Administrative penalties; injunctions; emergency
9278	orders; moratoriums.--
9279	(1)  The agency may deny, revoke, and or suspend a license,
9280	and or impose an administrative fine not to exceed $5,000 per
9281	violation, per day, or initiate injunctive proceedings under s.
9282	408.816 400.956.
9283	(2)  Any of the following actions by an employee of a home
9284	medical equipment provider or any of its employees is grounds
9285	for administrative action or penalties by the agency:
9286	(a)  Violation of this part or of applicable rules.
9287	(b)  An intentional, reckless, or negligent act that
9288	materially affects the health or safety of a patient.
9289	(3)  The agency may deny and or revoke the license of any
9290	applicant that:
9291	(a)  Made a false representation or omission of any
9292	material fact in making the application, including the
9293	submission of an application that conceals the controlling or
9294	ownership interest or any officer, director, agent, managing
9295	employee, affiliated person, partner, or shareholder who may not
9296	be eligible to participate;
9297	(a)(b)  Has been previously found by any professional
9298	licensing, certifying, or standards board or agency to have
9299	violated the standards or conditions relating to licensure or
9300	certification or the quality of services provided. "Professional
9301	licensing, certifying, or standards board or agency" shall
9302	include, but is not limited to, practitioners, health care
9303	facilities, programs, or services, or residential care,
9304	treatment programs, or other human services; or
9305	(b)(c)  Has been or is currently excluded, suspended, or
9306	terminated from, or has involuntarily withdrawn from,
9307	participation in Florida's Medicaid program or any other state's
9308	Medicaid program, or participation in the Medicare program or
9309	any other governmental or private health care or health
9310	insurance program.
9311	(4)  The agency may issue an emergency order immediately
9312	suspending or revoking a license when it determines that any
9313	condition within the responsibility of the home medical
9314	equipment provider presents a clear and present danger to public
9315	health and safety.
9316	(5)  The agency may impose an immediate moratorium on any
9317	licensed home medical equipment provider when the agency
9318	determines that any condition within the responsibility of the
9319	home medical equipment provider presents a threat to public
9320	health or safety.
9321	Section 176.  Section 400.933, Florida Statutes, is amended
9322	to read:
9323	400.933  Licensure inspections; alternatives and
9324	investigations.--
9325	(1)  The agency shall make or cause to be made such
9326	inspections and investigations as it considers necessary,
9327	including:
9328	(a)  Licensure inspections.
9329	(b)  Inspections directed by the federal Health Care
9330	Financing Administration.
9331	(c)  Licensure complaint investigations, including full
9332	licensure investigations with a review of all licensure
9333	standards as outlined in the administrative rules. Complaints
9334	received by the agency from individuals, organizations, or other
9335	sources are subject to review and investigation by the agency.
9336	(2)  The agency shall accept, in lieu of its own periodic
9337	inspections for licensure, submission of the following:
9338	(1)(a)  The survey or inspection of an accrediting
9339	organization, provided the accreditation of the licensed home
9340	medical equipment provider is not provisional and provided the
9341	licensed home medical equipment provider authorizes release of,
9342	and the agency receives the report of, the accrediting
9343	organization; or
9344	(2)(b)  A copy of a valid medical oxygen retail
9345	establishment permit issued by the Department of Health,
9346	pursuant to chapter 499.
9347	Section 177.  Section 400.935, Florida Statutes, is amended
9348	to read:
9349	400.935  Rules establishing minimum standards.--The agency
9350	shall adopt, publish, and enforce rules to implement this part
9351	and part II of chapter 408, which must provide reasonable and
9352	fair minimum standards relating to:
9353	(1)  The qualifications and minimum training requirements
9354	of all home medical equipment provider personnel.
9355	(2)  License application and renewal.
9356	(3)  License and inspection fees.
9357	(2)(4)  Financial ability to operate.
9358	(3)(5)  The administration of the home medical equipment
9359	provider.
9360	(4)(6)  Procedures for maintaining patient records.
9361	(5)(7)  Ensuring that the home medical equipment and
9362	services provided by a home medical equipment provider are in
9363	accordance with the plan of treatment established for each
9364	patient, when provided as a part of a plan of treatment.
9365	(6)(8)  Contractual arrangements for the provision of home
9366	medical equipment and services by providers not employed by the
9367	home medical equipment provider providing for the consumer's
9368	needs.
9369	(7)(9)  Physical location and zoning requirements.
9370	(8)(10)  Home medical equipment requiring home medical
9371	equipment services.
9372	Section 178.  Section 400.95, Florida Statutes, is
9373	repealed.
9374	Section 179.  Subsections (3) through (7) of section
9375	400.953, Florida Statutes, are renumbered as subsections (2)
9376	through (6), respectively, and present subsection (2) is amended
9377	to read:
9378	400.953  Background screening of home medical equipment
9379	provider personnel.--The agency shall require employment
9380	screening as provided in chapter 435, using the level 1
9381	standards for screening set forth in that chapter, for home
9382	medical equipment provider personnel.
9383	(2)  The general manager of each home medical equipment
9384	provider must sign an affidavit annually, under penalty of
9385	perjury, stating that all home medical equipment provider
9386	personnel hired on or after July 1, 1999, who enter the home of
9387	a patient in the capacity of their employment have been screened
9388	and that its remaining personnel have worked for the home
9389	medical equipment provider continuously since before July 1,
9390	1999.
9391	Section 180.  Subsection (4) of section 400.955, Florida
9392	Statutes, is amended to read:
9393	400.955  Procedures for screening of home medical equipment
9394	provider personnel.--
9395	(4)  The general manager of each home medical equipment
9396	provider must sign an affidavit annually, under penalty of
9397	perjury, stating that all personnel hired on or after July 1,
9398	1999, have been screened and that its remaining personnel have
9399	worked for the home medical equipment provider continuously
9400	since before July 1, 1999.
9401	Section 181.  Section 400.956, Florida Statutes, is
9402	repealed.
9403	Section 182.  Section 400.960, Florida Statutes, is amended
9404	to read:
9405	400.960  Definitions.--As used in this part, the term:
9406	(1)  "Active treatment" means the provision of services by
9407	an interdisciplinary team which are necessary to maximize a
9408	resident's client's individual independence or prevent
9409	regression or loss of functional status.
9410	(2)  "Agency" means the Agency for Health Care
9411	Administration.
9412	(3)  "Autism" means a pervasive, neurologically based
9413	developmental disability of extended duration which causes
9414	severe learning, communication, and behavior disorders with age
9415	of onset during infancy or childhood. Individuals with autism
9416	exhibit impairment in reciprocal social interaction, impairment
9417	in verbal and nonverbal communication and imaginative ability,
9418	and a markedly restricted repertoire of activities and
9419	interests.
9420	(4)  "Cerebral palsy" means a group of disabling symptoms
9421	of extended duration which results from damage to the developing
9422	brain occurring before, during, or after birth and resulting in
9423	the loss or impairment of control over voluntary muscles. The
9424	term does not include those symptoms or impairments resulting
9425	solely from a stroke.
9426	(5)  "Client" means any person determined by the department
9427	to be eligible for developmental services.
9428	(6)  "Client advocate" means a friend or relative of the
9429	client, or of the client's immediate family, who advocates for
9430	the best interests of the client in any proceedings under this
9431	part in which the client or his or her family has the right or
9432	duty to participate.
9433	(5)(7)  "Department" means the Department of Children and
9434	Family Services.
9435	(6)(8)  "Developmental disability" means a disorder or
9436	syndrome that is attributable to retardation, cerebral palsy,
9437	autism, spina bifida, or Prader-Willi syndrome and that
9438	constitutes a substantial handicap that can reasonably be
9439	expected to continue indefinitely.
9440	(7)(9)  "Direct service provider" means a person 18 years
9441	of age or older who has direct contact with individuals with
9442	developmental disabilities and who is unrelated to the
9443	individuals with developmental disabilities.
9444	(8)(10)  "Epilepsy" means a chronic brain disorder of
9445	various causes which is characterized by recurrent seizures due
9446	to excessive discharge of cerebral neurons. When found
9447	concurrently with retardation, autism, or cerebral palsy,
9448	epilepsy is considered a secondary disability for which the
9449	resident client is eligible to receive services to ameliorate
9450	this condition according to the provisions of this part.
9451	(9)(11)  "Guardian advocate" means a person appointed by
9452	the circuit court to represent a person with developmental
9453	disabilities in any proceedings brought pursuant to s. 393.12,
9454	and is distinct from a guardian advocate for mentally ill
9455	persons under chapter 394.
9456	(10)(12)  "Intermediate care facility for the
9457	developmentally disabled" means a residential facility licensed
9458	and certified in accordance with state law, and certified by the
9459	Federal Government, pursuant to the Social Security Act, as a
9460	provider of Medicaid services to persons who are developmentally
9461	disabled.
9462	(11)(13)  "Prader-Willi syndrome" means an inherited
9463	condition typified by neonatal hypotonia with failure to thrive,
9464	hyperphagia, or an excessive drive to eat which leads to
9465	obesity, usually at 18 to 36 months of age, mild to moderate
9466	retardation, hypogonadism, short stature, mild facial
9467	dysmorphism, and a characteristic neurobehavior.
9468	(12)  "Resident" means any person receiving services in an
9469	intermediate care facility.
9470	(13)  "Resident advocate" means a friend or relative of the
9471	resident, or of the resident's immediate family, who advocates
9472	for the best interests of the resident in any proceedings under
9473	this part in which the resident or his or her family has the
9474	right or duty to participate.
9475	(14)  "Retardation" means significantly subaverage general
9476	intellectual functioning existing concurrently with deficits in
9477	adaptive behavior and manifested during the period from
9478	conception to age 18. "Significantly subaverage general
9479	intellectual functioning," for the purpose of this definition,
9480	means performance that is two or more standard deviations from
9481	the mean score on a standardized intelligence test specified in
9482	rules of the department. "Deficits in adaptive behavior," for
9483	the purpose of this definition, means deficits in the
9484	effectiveness or degree with which an individual meets the
9485	standards of personal independence and social responsibility
9486	expected of his or her age, cultural group, and community.
9487	(15)  "Spina bifida" means a medical diagnosis of spina
9488	bifida cystica or myelomeningocele.
9489	Section 183.  Section 400.962, Florida Statutes, is amended
9490	to read:
9491	400.962  License required; license application.--
9492	(1)  The requirements of part II of chapter 408 shall apply
9493	to the provision of services that require licensure pursuant to
9494	this part and part II of chapter 408 and to entities licensed by
9495	or applying for such licensure from the Agency for Health Care
9496	Administration pursuant to this part. However, each applicant
9497	for licensure and each licensee is exempt from s. 408.810(7). It
9498	is unlawful to operate an intermediate care facility for the
9499	developmentally disabled without a license.
9500	(2)  Separate licenses are required for facilities
9501	maintained on separate premises even if operated under the same
9502	management. However, a separate license is not required for
9503	separate buildings on the same grounds.
9504	(3)  In accordance with s. 408.805, an applicant or
9505	licensee shall pay a fee for each license application submitted
9506	under this part, part II of chapter 408, and applicable rules.
9507	The amount of the fee shall be $234 per bed unless modified by
9508	rule.
9509	(3)  The basic license fee collected shall be deposited in
9510	the Health Care Trust Fund, established for carrying out the
9511	purposes of this chapter.
9512	(4)  The license must be conspicuously displayed inside the
9513	facility.
9514	(5)  A license is valid only in the hands of the
9515	individual, firm, partnership, association, or corporation to
9516	whom it is issued. A license is not valid for any premises other
9517	than those for which it was originally issued and may not be
9518	sold, assigned, or otherwise transferred, voluntarily or
9519	involuntarily.
9520	(6)  An application for a license shall be made to the
9521	agency on forms furnished by it and must be accompanied by the
9522	appropriate license fee.
9523	(7)  The application must be under oath and must contain
9524	the following:
9525	(a)  The name, address, and social security number of the
9526	applicant if an individual; if the applicant is a firm,
9527	partnership, or association, its name, address, and employer
9528	identification number (EIN), and the name and address of every
9529	member; if the applicant is a corporation, its name, address,
9530	and employer identification number (EIN), and the name and
9531	address of its director and officers and of each person having
9532	at least a 5 percent interest in the corporation; and the name
9533	by which the facility is to be known.
9534	(b)  The name of any person whose name is required on the
9535	application under paragraph (a) and who owns at least a 10
9536	percent interest in any professional service, firm, association,
9537	partnership, or corporation providing goods, leases, or services
9538	to the facility for which the application is made, and the name
9539	and address of the professional service, firm, association,
9540	partnership, or corporation in which such interest is held.
9541	(c)  The location of the facility for which a license is
9542	sought and an indication that such location conforms to the
9543	local zoning ordinances.
9544	(d)  The name of the persons under whose management or
9545	supervision the facility will be operated.
9546	(e)  The total number of beds.
9547	(4)(8)  The applicant must demonstrate that sufficient
9548	numbers of staff, qualified by training or experience, will be
9549	employed to properly care for the type and number of residents
9550	who will reside in the facility.
9551	(9)  The applicant must submit evidence that establishes
9552	the good moral character of the applicant, manager, supervisor,
9553	and administrator. An applicant who is an individual or a member
9554	of a board of directors or officer of an applicant that is a
9555	firm, partnership, association, or corporation must not have
9556	been convicted, or found guilty, regardless of adjudication, of
9557	a crime in any jurisdiction which affects or may potentially
9558	affect residents in the facility.
9559	(10)(a)  Upon receipt of a completed, signed, and dated
9560	application, the agency shall require background screening of
9561	the applicant, in accordance with the level 2 standards for
9562	screening set forth in chapter 435. As used in this subsection,
9563	the term "applicant" means the facility administrator, or
9564	similarly titled individual who is responsible for the day-to-
9565	day operation of the licensed facility, and the facility
9566	financial officer, or similarly titled individual who is
9567	responsible for the financial operation of the licensed
9568	facility.
9569	(b)  The agency may require background screening for a
9570	member of the board of directors of the licensee or an officer
9571	or an individual owning 5 percent or more of the licensee if the
9572	agency has probable cause to believe that such individual has
9573	been convicted of an offense prohibited under the level 2
9574	standards for screening set forth in chapter 435.
9575	(c)  Proof of compliance with the level 2 background
9576	screening requirements of chapter 435 which has been submitted
9577	within the previous 5 years in compliance with any other
9578	licensure requirements under this chapter satisfies the
9579	requirements of paragraph (a). Proof of compliance with
9580	background screening which has been submitted within the
9581	previous 5 years to fulfill the requirements of the Financial
9582	Services Commission and the Office of Insurance Regulation under
9583	chapter 651 as part of an application for a certificate of
9584	authority to operate a continuing care retirement community
9585	satisfies the requirements for the Department of Law Enforcement
9586	and Federal Bureau of Investigation background checks.
9587	(d)  A provisional license may be granted to an applicant
9588	when each individual required by this section to undergo
9589	background screening has met the standards for the Department of
9590	Law Enforcement background check, but the agency has not yet
9591	received background screening results from the Federal Bureau of
9592	Investigation, or a request for a disqualification exemption has
9593	been submitted to the agency as set forth in chapter 435, but a
9594	response has not yet been issued. A license may be granted to
9595	the applicant upon the agency's receipt of a report of the
9596	results of the Federal Bureau of Investigation background
9597	screening for each individual required by this section to
9598	undergo background screening which confirms that all standards
9599	have been met, or upon the granting of a disqualification
9600	exemption by the agency as set forth in chapter 435. Any other
9601	person who is required to undergo level 2 background screening
9602	may serve in his or her capacity pending the agency's receipt of
9603	the report from the Federal Bureau of Investigation; however,
9604	the person may not continue to serve if the report indicates any
9605	violation of background screening standards and a
9606	disqualification exemption has not been granted by the agency as
9607	set forth in chapter 435.
9608	(e)  Each applicant must submit to the agency, with its
9609	application, a description and explanation of any exclusions,
9610	permanent suspensions, or terminations of the applicant from the
9611	Medicare or Medicaid programs. Proof of compliance with
9612	disclosure of ownership and control interest requirements of the
9613	Medicaid or Medicare programs shall be accepted in lieu of this
9614	submission.
9615	(f)  Each applicant must submit to the agency a description
9616	and explanation of any conviction of an offense prohibited under
9617	the level 2 standards of chapter 435 by a member of the board of
9618	directors of the applicant, its officers, or any individual
9619	owning 5 percent or more of the applicant. This requirement does
9620	not apply to a director of a not-for-profit corporation or
9621	organization if the director serves solely in a voluntary
9622	capacity for the corporation or organization, does not regularly
9623	take part in the day-to-day operational decisions of the
9624	corporation or organization, receives no remuneration for his or
9625	her services on the corporation's or organization's board of
9626	directors, and has no financial interest and has no family
9627	members with a financial interest in the corporation or
9628	organization, provided that the director and the not-for-profit
9629	corporation or organization include in the application a
9630	statement affirming that the director's relationship to the
9631	corporation satisfies the requirements of this paragraph.
9632	(g)  An application for license renewal must contain the
9633	information required under paragraphs (e) and (f).
9634	(11)  The applicant must furnish satisfactory proof of
9635	financial ability to operate and conduct the facility in
9636	accordance with the requirements of this part and all rules
9637	adopted under this part, and the agency shall establish
9638	standards for this purpose.
9639	Section 184.  Section 400.963, Florida Statutes, is
9640	repealed.
9641	Section 185.  Section 400.965, Florida Statutes, is
9642	repealed.
9643	Section 186.  Section 400.967, Florida Statutes, is amended
9644	to read:
9645	400.967  Rules and classification of deficiencies.--
9646	(1)  It is the intent of the Legislature that rules adopted
9647	and enforced under this part and part II of chapter 408 include
9648	criteria by which a reasonable and consistent quality of
9649	resident care may be ensured, the results of such resident care
9650	can be demonstrated, and safe and sanitary facilities can be
9651	provided.
9652	(2)  Pursuant to the intention of the Legislature, the
9653	agency, in consultation with the Agency for Persons with
9654	Disabilities Department of Children and Family Services and the
9655	Department of Elderly Affairs, shall adopt and enforce rules to
9656	administer this part, which shall include reasonable and fair
9657	criteria governing:
9658	(a)  The location and construction of the facility;
9659	including fire and life safety, plumbing, heating, cooling,
9660	lighting, ventilation, and other housing conditions that will
9661	ensure the health, safety, and comfort of residents. The agency
9662	shall establish standards for facilities and equipment to
9663	increase the extent to which new facilities and a new wing or
9664	floor added to an existing facility after July 1, 2000, are
9665	structurally capable of serving as shelters only for residents,
9666	staff, and families of residents and staff, and equipped to be
9667	self-supporting during and immediately following disasters. The
9668	Agency for Health Care Administration shall work with facilities
9669	licensed under this part and report to the Governor and the
9670	Legislature by April 1, 2000, its recommendations for cost-
9671	effective renovation standards to be applied to existing
9672	facilities. In making such rules, the agency shall be guided by
9673	criteria recommended by nationally recognized, reputable
9674	professional groups and associations having knowledge concerning
9675	such subject matters. The agency shall update or revise such
9676	criteria as the need arises. All facilities must comply with
9677	those lifesafety code requirements and building code standards
9678	applicable at the time of approval of their construction plans.
9679	The agency may require alterations to a building if it
9680	determines that an existing condition constitutes a distinct
9681	hazard to life, health, or safety. The agency shall adopt fair
9682	and reasonable rules setting forth conditions under which
9683	existing facilities undergoing additions, alterations,
9684	conversions, renovations, or repairs are required to comply with
9685	the most recent updated or revised standards.
9686	(b)  The number and qualifications of all personnel,
9687	including management, medical nursing, and other personnel,
9688	having responsibility for any part of the care given to
9689	residents.
9690	(c)  All sanitary conditions within the facility and its
9691	surroundings, including water supply, sewage disposal, food
9692	handling, and general hygiene, which will ensure the health and
9693	comfort of residents.
9694	(d)  The equipment essential to the health and welfare of
9695	the residents.
9696	(e)  A uniform accounting system.
9697	(f)  The care, treatment, and maintenance of residents and
9698	measurement of the quality and adequacy thereof.
9699	(g)  The preparation and annual update of a comprehensive
9700	emergency management plan. The agency shall adopt rules
9701	establishing minimum criteria for the plan after consultation
9702	with the Department of Community Affairs. At a minimum, the
9703	rules must provide for plan components that address emergency
9704	evacuation transportation; adequate sheltering arrangements;
9705	postdisaster activities, including emergency power, food, and
9706	water; postdisaster transportation; supplies; staffing;
9707	emergency equipment; individual identification of residents and
9708	transfer of records; and responding to family inquiries. The
9709	comprehensive emergency management plan is subject to review and
9710	approval by the local emergency management agency. During its
9711	review, the local emergency management agency shall ensure that
9712	the following agencies, at a minimum, are given the opportunity
9713	to review the plan: the Department of Elderly Affairs, the
9714	Department of Children and Family Services, the Agency for
9715	Health Care Administration, and the Department of Community
9716	Affairs. Also, appropriate volunteer organizations must be given
9717	the opportunity to review the plan. The local emergency
9718	management agency shall complete its review within 60 days and
9719	either approve the plan or advise the facility of necessary
9720	revisions.
9721	(h)  Each licensee shall post its license in a prominent
9722	place that is in clear and unobstructed public view at or near
9723	the place where residents are being admitted to the facility.
9724	(3)  In accordance with part II of chapter 408, the agency
9725	shall adopt rules to provide that, when the criteria established
9726	under this part and part II of chapter 408 subsection (2) are
9727	not met, such deficiencies shall be classified according to the
9728	nature of the deficiency. The agency shall indicate the
9729	classification on the face of the notice of deficiencies as
9730	follows:
9731	(a)  Class I deficiencies are those which the agency
9732	determines present an and imminent danger to the residents or
9733	guests of the facility or a substantial probability that death
9734	or serious physical harm would result therefrom. The condition
9735	or practice constituting a class I violation must be abated or
9736	eliminated immediately, unless a fixed period of time, as
9737	determined by the agency, is required for correction.
9738	Notwithstanding s. 400.121(2), A class I deficiency is subject
9739	to a civil penalty in an amount not less than $5,000 and not
9740	exceeding $10,000 for each deficiency. A fine may be levied
9741	notwithstanding the correction of the deficiency.
9742	(b)  Class II deficiencies are those which the agency
9743	determines have a direct or immediate relationship to the
9744	health, safety, or security of the facility residents, other
9745	than class I deficiencies. A class II deficiency is subject to a
9746	civil penalty in an amount not less than $1,000 and not
9747	exceeding $5,000 for each deficiency. A citation for a class II
9748	deficiency shall specify the time within which the deficiency
9749	must be corrected. If a class II deficiency is corrected within
9750	the time specified, no civil penalty shall be imposed, unless it
9751	is a repeated offense.
9752	(c)  Class III deficiencies are those which the agency
9753	determines to have an indirect or potential relationship to the
9754	health, safety, or security of the facility residents, other
9755	than class I or class II deficiencies. A class III deficiency is
9756	subject to a civil penalty of not less than $500 and not
9757	exceeding $1,000 for each deficiency. A citation for a class III
9758	deficiency shall specify the time within which the deficiency
9759	must be corrected. If a class III deficiency is corrected within
9760	the time specified, no civil penalty shall be imposed, unless it
9761	is a repeated offense.
9762	(4)  Civil penalties paid by any licensee under subsection
9763	(3) shall be deposited in the Health Care Trust Fund and
9764	expended as provided in s. 400.063.
9765	(4)(5)  The agency shall approve or disapprove the plans
9766	and specifications within 60 days after receipt of the final
9767	plans and specifications. The agency may be granted one 15-day
9768	extension for the review period, if the secretary of the agency
9769	so approves. If the agency fails to act within the specified
9770	time, it is deemed to have approved the plans and
9771	specifications. When the agency disapproves plans and
9772	specifications, it must set forth in writing the reasons for
9773	disapproval. Conferences and consultations may be provided as
9774	necessary.
9775	(5)(6)  The agency may charge an initial fee of $2,000 for
9776	review of plans and construction on all projects, no part of
9777	which is refundable. The agency may also collect a fee, not to
9778	exceed 1 percent of the estimated construction cost or the
9779	actual cost of review, whichever is less, for the portion of the
9780	review which encompasses initial review through the initial
9781	revised construction document review. The agency may collect its
9782	actual costs on all subsequent portions of the review and
9783	construction inspections. Initial fee payment must accompany the
9784	initial submission of plans and specifications. Any subsequent
9785	payment that is due is payable upon receipt of the invoice from
9786	the agency. Notwithstanding any other provision of law, all
9787	money received by the agency under this section shall be deemed
9788	to be trust funds, to be held and applied solely for the
9789	operations required under this section.
9790	(6) Each licensee of an intermediate care facility for
9791	persons with developmental disabilities shall adhere to all
9792	rights specified in s. 393.13, the Bill of Rights of Persons Who
9793	are Developmentally Disabled.
9794	Section 187.  Section 400.968, Florida Statutes, is amended
9795	to read:
9796	400.968  Right of entry; protection of health, safety, and
9797	welfare.--
9798	(1)  Any designated officer or employee of the agency, of
9799	the state, or of the local fire marshal may enter unannounced
9800	the premises of any facility licensed under this part in order
9801	to determine the state of compliance with this part and the
9802	rules or standards in force under this part. The right of entry
9803	and inspection also extends to any premises that the agency has
9804	reason to believe are being operated or maintained as a facility
9805	without a license; but such an entry or inspection may not be
9806	made without the permission of the owner or person in charge of
9807	the facility unless a warrant that authorizes the entry is first
9808	obtained from the circuit court. The warrant requirement extends
9809	only to a facility that the agency has reason to believe is
9810	being operated or maintained as a facility without a license. An
9811	application for a license or renewal thereof which is made under
9812	this section constitutes permission for, and acquiescence in,
9813	any entry or inspection of the premises for which the license is
9814	sought, in order to facilitate verification of the information
9815	submitted in connection with the application; to discover,
9816	investigate, and determine the existence of abuse or neglect; or
9817	to elicit, receive, respond to, and resolve complaints. A
9818	current valid license constitutes unconditional permission for,
9819	and acquiescence in, any entry or inspection of the premises by
9820	authorized personnel. The agency retains the right of entry and
9821	inspection of facilities that have had a license revoked or
9822	suspended within the previous 24 months, to ensure that the
9823	facility is not operating unlawfully. However, before the
9824	facility is entered, a statement of probable cause must be filed
9825	with the director of the agency, who must approve or disapprove
9826	the action within 48 hours.
9827	(2)  The agency may institute injunctive proceedings in a
9828	court of competent jurisdiction for temporary or permanent
9829	relief to:
9830	(a)  Enforce this section or any minimum standard, rule, or
9831	order issued pursuant thereto if the agency's effort to correct
9832	a violation through administrative fines has failed or when the
9833	violation materially affects the health, safety, or welfare of
9834	residents; or
9835	(b)  Terminate the operation of a facility if a violation
9836	of this section or of any standard or rule adopted pursuant
9837	thereto exists which materially affects the health, safety, or
9838	welfare of residents.
9839
9840	The Legislature recognizes that, in some instances, action is
9841	necessary to protect residents of facilities from immediately
9842	life-threatening situations. If it appears by competent evidence
9843	or a sworn, substantiated affidavit that a temporary injunction
9844	should issue, the court, pending the determination on final
9845	hearing, shall enjoin operation of the facility.
9846	(3)  The agency may impose an immediate moratorium on
9847	admissions to a facility when the agency determines that any
9848	condition in the facility presents a threat to the health,
9849	safety, or welfare of the residents in the facility. If a
9850	facility's license is denied, revoked, or suspended, the
9851	facility may be subject to the immediate imposition of a
9852	moratorium on admissions to run concurrently with licensure
9853	denial, revocation, or suspension.
9854	Section 188.  Section 400.9685, Florida Statutes, is
9855	amended to read:
9856	400.9685  Administration of medication.--
9857	(1)  Notwithstanding the provisions of the Nurse Practice
9858	Act, part I of chapter 464, unlicensed direct care services
9859	staff who are providing services to residents clients in
9860	intermediate care facilities for the developmentally disabled,
9861	licensed pursuant to this part, may administer prescribed,
9862	prepackaged, premeasured medications under the general
9863	supervision of a registered nurse as provided in this section
9864	and applicable rules. Training required by this section and
9865	applicable rules must be conducted by a registered nurse
9866	licensed pursuant to chapter 464 or a physician licensed
9867	pursuant to chapter 458 or chapter 459.
9868	(2)  Each facility that allows unlicensed direct care
9869	service staff to administer medications pursuant to this section
9870	must:
9871	(a)  Develop and implement policies and procedures that
9872	include a plan to ensure the safe handling, storage, and
9873	administration of prescription medication.
9874	(b)  Maintain written evidence of the expressed and
9875	informed consent for each resident client.
9876	(c)  Maintain a copy of the written prescription including
9877	the name of the medication, the dosage, and administration
9878	schedule.
9879	(d)  Maintain documentation regarding the prescription
9880	including the name, dosage, and administration schedule, reason
9881	for prescription, and the termination date.
9882	(e)  Maintain documentation of compliance with required
9883	training.
9884	(3)  Agency rules shall specify the following as it relates
9885	to the administration of medications by unlicensed staff:
9886	(a)  Medications authorized and packaging required.
9887	(b)  Acceptable methods of administration.
9888	(c)  A definition of "general supervision."
9889	(d)  Minimum educational requirements of staff.
9890	(e)  Criteria of required training and competency that must
9891	be demonstrated prior to the administration of medications by
9892	unlicensed staff including inservice training.
9893	(f)  Requirements for safe handling, storage, and
9894	administration of medications.
9895	Section 189.  Subsection (1) of section 400.969, Florida
9896	Statutes, is amended to read:
9897	400.969  Violation of part; penalties.--
9898	(1)  In accordance with part II of chapter 408, and except
9899	as provided in s. 400.967(3), a violation of any provision of
9900	this part, part II of chapter 408, or applicable rules adopted
9901	by the agency under this part is punishable by payment of an
9902	administrative or civil penalty not to exceed $5,000.
9903	Section 190.  Section 400.980, Florida Statutes, is amended
9904	to read:
9905	400.980  Health care services pools.--
9906	(1)  As used in this section, the term:
9907	(a)  "Agency" means the Agency for Health Care
9908	Administration.
9909	(b)  "Health care services pool" means any person, firm,
9910	corporation, partnership, or association engaged for hire in the
9911	business of providing temporary employment in health care
9912	facilities, residential facilities, and agencies for licensed,
9913	certified, or trained health care personnel including, without
9914	limitation, nursing assistants, nurses' aides, and orderlies.
9915	However, the term does not include nursing registries, a
9916	facility licensed under chapter 400, a health care services pool
9917	established within a health care facility to provide services
9918	only within the confines of such facility, or any individual
9919	contractor directly providing temporary services to a health
9920	care facility without use or benefit of a contracting agent.
9921	(2)  The requirements of part II of chapter 408 shall apply
9922	to the provision of services that require licensure or
9923	registration pursuant to this part and part II of chapter 408
9924	and to entities registered by or applying for such registration
9925	from the agency pursuant to this part. However, each applicant
9926	for licensure and each licensee is exempt from ss.
9927	408.806(1)(e)2. and 408.810(6)-(10). Each person who operates a
9928	health care services pool must register each separate business
9929	location with the agency. The agency shall adopt rules and
9930	provide forms required for such registration and shall impose a
9931	registration fee in an amount sufficient to cover the cost of
9932	administering this section. In addition, the registrant must
9933	provide the agency with any change of information contained on
9934	the original registration application within 14 days prior to
9935	the change. The agency may inspect the offices of any health
9936	care services pool at any reasonable time for the purpose of
9937	determining compliance with this section or the rules adopted
9938	under this section.
9939	(3)  Each application for registration must include:
9940	(a)  The name and address of any person who has an
9941	ownership interest in the business, and, in the case of a
9942	corporate owner, copies of the articles of incorporation,
9943	bylaws, and names and addresses of all officers and directors of
9944	the corporation.
9945	(b)  Any other information required by the agency.
9946	(3)(4)  Each applicant for registration must comply with
9947	the following requirements:
9948	(a)  Upon receipt of a completed, signed, and dated
9949	application, the agency shall require background screening, in
9950	accordance with the level 1 standards for screening set forth in
9951	chapter 435, of every individual who will have contact with
9952	patients. The agency shall require background screening of the
9953	managing employee or other similarly titled individual who is
9954	responsible for the operation of the entity, and of the
9955	financial officer or other similarly titled individual who is
9956	responsible for the financial operation of the entity, including
9957	billings for services in accordance with the level 2 standards
9958	for background screening as set forth in chapter 435.
9959	(b)  The agency may require background screening of any
9960	other individual who is affiliated with the applicant if the
9961	agency has a reasonable basis for believing that he or she has
9962	been convicted of a crime or has committed any other offense
9963	prohibited under the level 2 standards for screening set forth
9964	in chapter 435.
9965	(c)  Proof of compliance with the level 2 background
9966	screening requirements of chapter 435 which has been submitted
9967	within the previous 5 years in compliance with any other health
9968	care or assisted living licensure requirements of this state is
9969	acceptable in fulfillment of paragraph (a).
9970	(d)  A provisional registration may be granted to an
9971	applicant when each individual required by this section to
9972	undergo background screening has met the standards for the
9973	Department of Law Enforcement background check but the agency
9974	has not yet received background screening results from the
9975	Federal Bureau of Investigation. A standard registration may be
9976	granted to the applicant upon the agency's receipt of a report
9977	of the results of the Federal Bureau of Investigation background
9978	screening for each individual required by this section to
9979	undergo background screening which confirms that all standards
9980	have been met, or upon the granting of a disqualification
9981	exemption by the agency as set forth in chapter 435. Any other
9982	person who is required to undergo level 2 background screening
9983	may serve in his or her capacity pending the agency's receipt of
9984	the report from the Federal Bureau of Investigation. However,
9985	the person may not continue to serve if the report indicates any
9986	violation of background screening standards and if a
9987	disqualification exemption has not been requested of and granted
9988	by the agency as set forth in chapter 435.
9989	(e)  Each applicant must submit to the agency, with its
9990	application, a description and explanation of any exclusions,
9991	permanent suspensions, or terminations of the applicant from the
9992	Medicare or Medicaid programs. Proof of compliance with the
9993	requirements for disclosure of ownership and controlling
9994	interests under the Medicaid or Medicare programs may be
9995	accepted in lieu of this submission.
9996	(f)  Each applicant must submit to the agency a description
9997	and explanation of any conviction of an offense prohibited under
9998	the level 2 standards of chapter 435 which was committed by a
9999	member of the board of directors of the applicant, its officers,
10000	or any individual owning 5 percent or more of the applicant.
10001	This requirement does not apply to a director of a not-for-
10002	profit corporation or organization who serves solely in a
10003	voluntary capacity for the corporation or organization, does not
10004	regularly take part in the day-to-day operational decisions of
10005	the corporation or organization, receives no remuneration for
10006	his or her services on the corporation's or organization's board
10007	of directors, and has no financial interest and no family
10008	members having a financial interest in the corporation or
10009	organization, if the director and the not-for-profit corporation
10010	or organization include in the application a statement affirming
10011	that the director's relationship to the corporation satisfies
10012	the requirements of this paragraph.
10013	(g)  A registration may not be granted to an applicant if
10014	the applicant or managing employee has been found guilty of,
10015	regardless of adjudication, or has entered a plea of nolo
10016	contendere or guilty to, any offense prohibited under the level
10017	2 standards for screening set forth in chapter 435, unless an
10018	exemption from disqualification has been granted by the agency
10019	as set forth in chapter 435.
10020	(h)  Failure to provide all required documentation within
10021	30 days after a written request from the agency will result in
10022	denial of the application for registration.
10023	(i)  The agency must take final action on an application
10024	for registration within 60 days after receipt of all required
10025	documentation.
10026	(j)  The agency may deny, revoke, or suspend the
10027	registration of any applicant or registrant who:
10028	1.  Has falsely represented a material fact in the
10029	application required by paragraph (e) or paragraph (f), or has
10030	omitted any material fact from the application required by
10031	paragraph (e) or paragraph (f); or
10032	2.  Has had prior action taken against the applicant under
10033	the Medicaid or Medicare program as set forth in paragraph (e).
10034	3.  Fails to comply with this section or applicable rules.
10035	4.  Commits an intentional, reckless, or negligent act that
10036	materially affects the health or safety of a person receiving
10037	services.
10038	(4)(5)  It is a misdemeanor of the first degree, punishable
10039	under s. 775.082 or s. 775.083, for any person willfully,
10040	knowingly, or intentionally to:
10041	(a)  Fail, by false statement, misrepresentation,
10042	impersonation, or other fraudulent means, to disclose in any
10043	application for voluntary or paid employment a material fact
10044	used in making a determination as to an applicant's
10045	qualifications to be a contractor under this section;
10046	(b)  Operate or attempt to operate an entity registered
10047	under this part with persons who do not meet the minimum
10048	standards of chapter 435 as contained in this section; or
10049	(c)  Use information from the criminal records obtained
10050	under this section for any purpose other than screening an
10051	applicant for temporary employment as specified in this section,
10052	or release such information to any other person for any purpose
10053	other than screening for employment under this section.
10054	(5)(6)  It is a felony of the third degree, punishable
10055	under s. 775.082, s. 775.083, or s. 775.084, for any person
10056	willfully, knowingly, or intentionally to use information from
10057	the juvenile records of a person obtained under this section for
10058	any purpose other than screening for employment under this
10059	section.
10060	(7)  It is unlawful for a person to offer or advertise
10061	services, as defined by rule, to the public without obtaining a
10062	certificate of registration from the Agency for Health Care
10063	Administration. It is unlawful for any holder of a certificate
10064	of registration to advertise or hold out to the public that he
10065	or she holds a certificate of registration for other than that
10066	for which he or she actually holds a certificate of
10067	registration. Any person who violates this subsection is subject
10068	to injunctive proceedings under s. 400.515.
10069	(8)  Each registration shall be for a period of 2 years.
10070	The application for renewal must be received by the agency at
10071	least 30 days before the expiration date of the registration. An
10072	application for a new registration is required within 30 days
10073	prior to the sale of a controlling interest in a health care
10074	services pool.
10075	(6)(9)  A health care services pool may not require an
10076	employee to recruit new employees from persons employed at a
10077	health care facility to which the health care services pool
10078	employee is assigned. Nor shall a health care facility to which
10079	employees of a health care services pool are assigned recruit
10080	new employees from the health care services pool.
10081	(7)(10)  A health care services pool shall document that
10082	each temporary employee provided to a health care facility has
10083	met the licensing, certification, training, or continuing
10084	education requirements, as established by the appropriate
10085	regulatory agency, for the position in which he or she will be
10086	working.
10087	(8)(11)  When referring persons for temporary employment in
10088	health care facilities, a health care services pool shall comply
10089	with all pertinent state and federal laws, rules, and
10090	regulations relating to health, background screening, and other
10091	qualifications required of persons working in a facility of that
10092	type.
10093	(9)(12)(a)  As a condition of registration and prior to the
10094	issuance or renewal of a certificate of registration, a health
10095	care services pool applicant must prove financial responsibility
10096	to pay claims, and costs ancillary thereto, arising out of the
10097	rendering of services or failure to render services by the pool
10098	or by its employees in the course of their employment with the
10099	pool. The agency shall promulgate rules establishing minimum
10100	financial responsibility coverage amounts which shall be
10101	adequate to pay potential claims and costs ancillary thereto.
10102	(b)  Each health care services pool shall give written
10103	notification to the agency within 20 days after any change in
10104	the method of assuring financial responsibility or upon
10105	cancellation or nonrenewal of professional liability insurance.
10106	Unless the pool demonstrates that it is otherwise in compliance
10107	with the requirements of this section, the agency shall suspend
10108	the registration of the pool pursuant to ss. 120.569 and 120.57.
10109	Any suspension under this section shall remain in effect until
10110	the pool demonstrates compliance with the requirements of this
10111	section.
10112	(c)  Proof of financial responsibility must be demonstrated
10113	to the satisfaction of the agency, through one of the following
10114	methods:
10115	1.  Establishing and maintaining an escrow account
10116	consisting of cash or assets eligible for deposit in accordance
10117	with s. 625.52;
10118	2.  Obtaining and maintaining an unexpired irrevocable
10119	letter of credit established pursuant to chapter 675. Such
10120	letters of credit shall be nontransferable and nonassignable and
10121	shall be issued by any bank or savings association organized and
10122	existing under the laws of this state or any bank or savings
10123	association organized under the laws of the United States that
10124	has its principal place of business in this state or has a
10125	branch office which is authorized under the laws of this state
10126	or of the United States to receive deposits in this state; or
10127	3.  Obtaining and maintaining professional liability
10128	coverage from one of the following:
10129	a.  An authorized insurer as defined under s. 624.09;
10130	b.  An eligible surplus lines insurer as defined under s.
10131	626.918(2);
10132	c.  A risk retention group or purchasing group as defined
10133	under s. 627.942; or
10134	d.  A plan of self-insurance as provided in s. 627.357.
10135	(d)  If financial responsibility requirements are met by
10136	maintaining an escrow account or letter of credit, as provided
10137	in this section, upon the entry of an adverse final judgment
10138	arising from a medical malpractice arbitration award from a
10139	claim of medical malpractice either in contract or tort, or from
10140	noncompliance with the terms of a settlement agreement arising
10141	from a claim of medical malpractice either in contract or tort,
10142	the financial institution holding the escrow account or the
10143	letter of credit shall pay directly to the claimant the entire
10144	amount of the judgment together with all accrued interest or the
10145	amount maintained in the escrow account or letter of credit as
10146	required by this section, whichever is less, within 60 days
10147	after the date such judgment became final and subject to
10148	execution, unless otherwise mutually agreed to in writing by the
10149	parties. If timely payment is not made, the agency shall suspend
10150	the registration of the pool pursuant to procedures set forth by
10151	the agency through rule. Nothing in this paragraph shall
10152	abrogate a judgment debtor's obligation to satisfy the entire
10153	amount of any judgment.
10154	(e)  Each health care services pool carrying claims-made
10155	coverage must demonstrate proof of extended reporting coverage
10156	through either tail or nose coverage, in the event the policy is
10157	canceled, replaced, or not renewed. Such extended coverage shall
10158	provide coverage for incidents that occurred during the claims-
10159	made policy period but were reported after the policy period.
10160	(f)  The financial responsibility requirements of this
10161	section shall apply to claims for incidents that occur on or
10162	after January 1, 1991, or the initial date of registration in
10163	this state, whichever is later.
10164	(g)  Meeting the financial responsibility requirements of
10165	this section must be established at the time of issuance or
10166	renewal of a certificate of registration.
10167	(10)(13)  The agency shall adopt rules to implement this
10168	section and part II of chapter 408, including rules providing
10169	for the establishment of:
10170	(a)  Minimum standards for the operation and administration
10171	of health care personnel pools, including procedures for
10172	recordkeeping and personnel.
10173	(b)  In accordance with part II of chapter 408, fines for
10174	the violation of this part, part II of chapter 408, or
10175	applicable rules section in an amount not to exceed $2,500 and
10176	suspension or revocation of registration.
10177	(c)  Disciplinary sanctions for failure to comply with this
10178	section or the rules adopted under this section.
10179	Section 191.  Section 400.991, Florida Statutes, is amended
10180	to read:
10181	400.991  License requirements; background screenings;
10182	prohibitions.--
10183	(1)(a)  The requirements of part II of chapter 408 shall
10184	apply to the provision of services that require licensure
10185	pursuant to this part and part II of chapter 408 and to entities
10186	licensed by or applying for such licensure from the agency
10187	pursuant to this part. However, each applicant for licensure and
10188	each licensee is exempt from the provisions of s. 408.810(6),
10189	(7), and (10). Each clinic, as defined in s. 400.9905, must be
10190	licensed and shall at all times maintain a valid license with
10191	the agency. Each clinic location shall be licensed separately
10192	regardless of whether the clinic is operated under the same
10193	business name or management as another clinic.
10194	(b)  Each mobile clinic must obtain a separate health care
10195	clinic license and must provide to the agency, at least
10196	quarterly, its projected street location to enable the agency to
10197	locate and inspect such clinic. A portable equipment provider
10198	must obtain a health care clinic license for a single
10199	administrative office and is not required to submit quarterly
10200	projected street locations.
10201	(2)  The initial clinic license application shall be filed
10202	with the agency by all clinics, as defined in s. 400.9905, on or
10203	before July 1, 2004. A clinic license must be renewed
10204	biennially.
10205	(3)  Applicants that submit an application on or before
10206	July 1, 2004, which meets all requirements for initial licensure
10207	as specified in this section shall receive a temporary license
10208	until the completion of an initial inspection verifying that the
10209	applicant meets all requirements in rules authorized in s.
10210	400.9925. However, a clinic engaged in magnetic resonance
10211	imaging services may not receive a temporary license unless it
10212	presents evidence satisfactory to the agency that such clinic is
10213	making a good faith effort and substantial progress in seeking
10214	accreditation required under s. 400.9935.
10215	(4)  Application for an initial clinic license or for
10216	renewal of an existing license shall be notarized on forms
10217	furnished by the agency and must be accompanied by the
10218	appropriate license fee as provided in s. 400.9925. The agency
10219	shall take final action on an initial license application within
10220	60 days after receipt of all required documentation.
10221	(4)(5)  The application shall contain information that
10222	includes, but need not be limited to, information pertaining to
10223	the name, residence and business address, phone number, social
10224	security number, and license number of the medical or clinic
10225	director, of the licensed medical providers employed or under
10226	contract with the clinic, and of each person who, directly or
10227	indirectly, owns or controls 5 percent or more of an interest in
10228	the clinic, or general partners in limited liability
10229	partnerships.
10230	(5)(6)  The applicant must file with the application
10231	satisfactory proof that the clinic is in compliance with this
10232	part and applicable rules, including:
10233	(a)  A listing of services to be provided either directly
10234	by the applicant or through contractual arrangements with
10235	existing providers;
10236	(b)  The number and discipline of each professional staff
10237	member to be employed; and
10238	(c)  Proof of financial ability to operate. An applicant
10239	must demonstrate financial ability to operate a clinic by
10240	submitting a balance sheet and an income and expense statement
10241	for the first year of operation which provide evidence of the
10242	applicant's having sufficient assets, credit, and projected
10243	revenues to cover liabilities and expenses. The applicant shall
10244	have demonstrated financial ability to operate if the
10245	applicant's assets, credit, and projected revenues meet or
10246	exceed projected liabilities and expenses. All documents
10247	required under this subsection must be prepared in accordance
10248	with generally accepted accounting principles, may be in a
10249	compilation form, and the financial statement must be signed by
10250	a certified public accountant. As an alternative to submitting
10251	proof of financial ability to operate as required under s.
10252	408.810(8) a balance sheet and an income and expense statement
10253	for the first year of operation, the applicant may file a surety
10254	bond of at least $500,000 which guarantees that the clinic will
10255	act in full conformity with all legal requirements for operating
10256	a clinic, payable to the agency. The agency may adopt rules to
10257	specify related requirements for such surety bond.
10258	(6)(7)  Background screening required under s. 408.809
10259	shall apply to licensed health care practitioners at the clinic.
10260	Each applicant for licensure shall comply with the following
10261	requirements:
10262	(a)  As used in this subsection, the term "applicant" means
10263	individuals owning or controlling, directly or indirectly, 5
10264	percent or more of an interest in a clinic; the medical or
10265	clinic director, or a similarly titled person who is responsible
10266	for the day-to-day operation of the licensed clinic; the
10267	financial officer or similarly titled individual who is
10268	responsible for the financial operation of the clinic; and
10269	licensed health care practitioners at the clinic.
10270	(b)  Upon receipt of a completed, signed, and dated
10271	application, the agency shall require background screening of
10272	the applicant, in accordance with the level 2 standards for
10273	screening set forth in chapter 435. Proof of compliance with the
10274	level 2 background screening requirements of chapter 435 which
10275	has been submitted within the previous 5 years in compliance
10276	with any other health care licensure requirements of this state
10277	is acceptable in fulfillment of this paragraph. Applicants who
10278	own less than 10 percent of a health care clinic are not
10279	required to submit fingerprints under this section.
10280	(c)  Each applicant must submit to the agency, with the
10281	application, a description and explanation of any exclusions,
10282	permanent suspensions, or terminations of an applicant from the
10283	Medicare or Medicaid programs. Proof of compliance with the
10284	requirements for disclosure of ownership and control interest
10285	under the Medicaid or Medicare programs may be accepted in lieu
10286	of this submission. The description and explanation may indicate
10287	whether such exclusions, suspensions, or terminations were
10288	voluntary or not voluntary on the part of the applicant.
10289	(d)  A license may not be granted to a clinic if the
10290	applicant has been found guilty of, regardless of adjudication,
10291	or has entered a plea of nolo contendere or guilty to, any
10292	offense prohibited under the level 2 standards for screening set
10293	forth in chapter 435, or a violation of insurance fraud under s.
10294	817.234, within the past 5 years. If the applicant has been
10295	convicted of an offense prohibited under the level 2 standards
10296	or insurance fraud in any jurisdiction, the applicant must show
10297	that his or her civil rights have been restored prior to
10298	submitting an application.
10299	(e)  The agency may deny or revoke licensure if the
10300	applicant has falsely represented any material fact or omitted
10301	any material fact from the application required by this part.
10302	(8)  Requested information omitted from an application for
10303	licensure, license renewal, or transfer of ownership must be
10304	filed with the agency within 21 days after receipt of the
10305	agency's request for omitted information, or the application
10306	shall be deemed incomplete and shall be withdrawn from further
10307	consideration.
10308	(9)  The failure to file a timely renewal application shall
10309	result in a late fee charged to the facility in an amount equal
10310	to 50 percent of the current license fee.
10311	Section 192.  Section 400.9915, Florida Statutes, is
10312	amended to read:
10313	400.9915  Clinic inspections; Emergency suspension;
10314	costs.--
10315	(1)  Any authorized officer or employee of the agency shall
10316	make inspections of the clinic as part of the initial license
10317	application or renewal application. The application for a clinic
10318	license issued under this part or for a renewal license
10319	constitutes permission for an appropriate agency inspection to
10320	verify the information submitted on or in connection with the
10321	application or renewal.
10322	(2)  An authorized officer or employee of the agency may
10323	make unannounced inspections of clinics licensed pursuant to
10324	this part as are necessary to determine that the clinic is in
10325	compliance with this part and with applicable rules. A licensed
10326	clinic shall allow full and complete access to the premises and
10327	to billing records or information to any representative of the
10328	agency who makes an inspection to determine compliance with this
10329	part and with applicable rules.
10330	(1)(3)  Failure by a clinic licensed under this part to
10331	allow full and complete access to the premises and to billing
10332	records or information to any representative of the agency who
10333	makes a request to inspect the clinic to determine compliance
10334	with this part or failure by a clinic to employ a qualified
10335	medical director or clinic director constitutes a ground for
10336	emergency suspension of the license by the agency pursuant to s.
10337	120.60(6) and part II of chapter 408.
10338	(2)(4)  In addition to any administrative fines imposed,
10339	the agency may assess a fee equal to the cost of conducting a
10340	complaint investigation.
10341	Section 193.  Section 400.992, Florida Statutes, is
10342	repealed.
10343	Section 194.  Section 400.9925, Florida Statutes, is
10344	amended to read:
10345	400.9925  Rulemaking authority; license fees.--
10346	(1)  The agency shall adopt rules necessary to administer
10347	the clinic administration, regulation, and licensure program,
10348	including rules pursuant to this part and part II of chapter
10349	408, establishing the specific licensure requirements,
10350	procedures, forms, and fees. It shall adopt rules establishing a
10351	procedure for the biennial renewal of licenses. The agency may
10352	issue initial licenses for less than the full 2-year period by
10353	charging a prorated licensure fee and specifying a different
10354	renewal date than would otherwise be required for biennial
10355	licensure. The rules shall specify the expiration dates of
10356	licenses, the process of tracking compliance with financial
10357	responsibility requirements, and any other conditions of renewal
10358	required by law or rule.
10359	(2)  The agency shall adopt rules specifying limitations on
10360	the number of licensed clinics and licensees for which a medical
10361	director or a clinic director may assume responsibility for
10362	purposes of this part. In determining the quality of supervision
10363	a medical director or a clinic director can provide, the agency
10364	shall consider the number of clinic employees, the clinic
10365	location, and the health care services provided by the clinic.
10366	(3)  In accordance with s. 408.805, an applicant or a
10367	licensee shall pay a fee for each license application submitted
10368	under this part, part II of chapter 408, and applicable rules.
10369	The amount of the fee shall be established by rule and shall not
10370	exceed $2,000 per biennium. License application and renewal fees
10371	must be reasonably calculated by the agency to cover its costs
10372	in carrying out its responsibilities under this part, including
10373	the cost of licensure, inspection, and regulation of clinics,
10374	and must be of such amount that the total fees collected do not
10375	exceed the cost of administering and enforcing compliance with
10376	this part. Clinic licensure fees are nonrefundable and may not
10377	exceed $2,000. The agency shall adjust the license fee annually
10378	by not more than the change in the Consumer Price Index based on
10379	the 12 months immediately preceding the increase. All fees
10380	collected under this part must be deposited in the Health Care
10381	Trust Fund for the administration of this part.
10382	Section 195.  Section 400.993, Florida Statutes, is amended
10383	to read:
10384	400.993  Unlicensed clinics; reporting penalties; fines;
10385	verification of licensure status.--
10386	(1)  It is unlawful to own, operate, or maintain a clinic
10387	without obtaining a license under this part.
10388	(2)  Any person who owns, operates, or maintains an
10389	unlicensed clinic commits a felony of the third degree,
10390	punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
10391	Each day of continued operation is a separate offense.
10392	(3)  Any person found guilty of violating subsection (2) a
10393	second or subsequent time commits a felony of the second degree,
10394	punishable as provided under s. 775.082, s. 775.083, or s.
10395	775.084. Each day of continued operation is a separate offense.
10396	(4)  Any person who owns, operates, or maintains an
10397	unlicensed clinic due to a change in this part or a modification
10398	in agency rules within 6 months after the effective date of such
10399	change or modification and who, within 10 working days after
10400	receiving notification from the agency, fails to cease operation
10401	or apply for a license under this part commits a felony of the
10402	third degree, punishable as provided in s. 775.082, s. 775.083,
10403	or s. 775.084. Each day of continued operation is a separate
10404	offense.
10405	(5)  Any clinic that fails to cease operation after agency
10406	notification may be fined for each day of noncompliance pursuant
10407	to this part.
10408	(6)  When a person has an interest in more than one clinic,
10409	and fails to obtain a license for any one of these clinics, the
10410	agency may revoke the license, impose a moratorium, or impose a
10411	fine pursuant to this part on any or all of the licensed clinics
10412	until such time as the unlicensed clinic is licensed or ceases
10413	operation.
10414	(7)  Any person aware of the operation of an unlicensed
10415	clinic must report that facility to the agency.
10416	(8)  In addition to the requirements of part II of chapter
10417	408, any health care provider who is aware of the operation of
10418	an unlicensed clinic shall report that facility to the agency.
10419	Failure to report a clinic that the provider knows or has
10420	reasonable cause to suspect is unlicensed shall be reported to
10421	the provider's licensing board.
10422	(9)  The agency may not issue a license to a clinic that
10423	has any unpaid fines assessed under this part.
10424	Section 196.  Section 400.9935, Florida Statutes, is
10425	amended to read:
10426	400.9935  Clinic responsibilities.--
10427	(1)  Each clinic shall appoint a medical director or clinic
10428	director who shall agree in writing to accept legal
10429	responsibility for the following activities on behalf of the
10430	clinic. The medical director or the clinic director shall:
10431	(a)  Have signs identifying the medical director or clinic
10432	director posted in a conspicuous location within the clinic
10433	readily visible to all patients.
10434	(b)  Ensure that all practitioners providing health care
10435	services or supplies to patients maintain a current active and
10436	unencumbered Florida license.
10437	(c)  Review any patient referral contracts or agreements
10438	executed by the clinic.
10439	(d)  Ensure that all health care practitioners at the
10440	clinic have active appropriate certification or licensure for
10441	the level of care being provided.
10442	(e)  Serve as the clinic records owner as defined in s.
10443	456.057.
10444	(f)  Ensure compliance with the recordkeeping, office
10445	surgery, and adverse incident reporting requirements of chapter
10446	456, the respective practice acts, and rules adopted under this
10447	part and part II of chapter 408.
10448	(g)  Conduct systematic reviews of clinic billings to
10449	ensure that the billings are not fraudulent or unlawful. Upon
10450	discovery of an unlawful charge, the medical director or clinic
10451	director shall take immediate corrective action. If the clinic
10452	performs only the technical component of magnetic resonance
10453	imaging, static radiographs, computed tomography, or positron
10454	emission tomography, and provides the professional
10455	interpretation of such services, in a fixed facility that is
10456	accredited by the Joint Commission on Accreditation of
10457	Healthcare Organizations or the Accreditation Association for
10458	Ambulatory Health Care, and the American College of Radiology;
10459	and if, in the preceding quarter, the percentage of scans
10460	performed by that clinic which was billed to all personal injury
10461	protection insurance carriers was less than 15 percent, the
10462	chief financial officer of the clinic may, in a written
10463	acknowledgment provided to the agency, assume the responsibility
10464	for the conduct of the systematic reviews of clinic billings to
10465	ensure that the billings are not fraudulent or unlawful.
10466	(2)  Any business that becomes a clinic after commencing
10467	operations must, within 5 days after becoming a clinic, file a
10468	license application under this part and shall be subject to all
10469	provisions of this part applicable to a clinic.
10470	(2)(3)  Any contract to serve as a medical director or a
10471	clinic director entered into or renewed by a physician or a
10472	licensed health care practitioner in violation of this part is
10473	void as contrary to public policy. This subsection shall apply
10474	to contracts entered into or renewed on or after March 1, 2004.
10475	(3)(4)  All charges or reimbursement claims made by or on
10476	behalf of a clinic that is required to be licensed under this
10477	part, but that is not so licensed, or that is otherwise
10478	operating in violation of this part, are unlawful charges, and
10479	therefore are noncompensable and unenforceable.
10480	(4)(5)  Any person establishing, operating, or managing an
10481	unlicensed clinic otherwise required to be licensed under this
10482	part, or any person who knowingly files a false or misleading
10483	license application or license renewal application, or false or
10484	misleading information related to such application or department
10485	rule, commits a felony of the third degree, punishable as
10486	provided in s. 775.082, s. 775.083, or s. 775.084.
10487	(5)(6)  Any licensed health care provider who violates this
10488	part is subject to discipline in accordance with this chapter
10489	and his or her respective practice act.
10490	(7)  The agency may fine, or suspend or revoke the license
10491	of, any clinic licensed under this part for operating in
10492	violation of the requirements of this part or the rules adopted
10493	by the agency.
10494	(8)  The agency shall investigate allegations of
10495	noncompliance with this part and the rules adopted under this
10496	part.
10497	(6)(9)  Any person or entity providing health care services
10498	which is not a clinic, as defined under s. 400.9905, may
10499	voluntarily apply for a certificate of exemption from licensure
10500	under its exempt status with the agency on a form that sets
10501	forth its name or names and addresses, a statement of the
10502	reasons why it cannot be defined as a clinic, and other
10503	information deemed necessary by the agency. An exemption is not
10504	transferable. The agency may charge an applicant for a
10505	certificate of exemption in an amount equal to $100 or the
10506	actual cost of processing the certificate, whichever is less.
10507	(10)  The clinic shall display its license in a conspicuous
10508	location within the clinic readily visible to all patients.
10509	(7)(11)(a)  Each clinic engaged in magnetic resonance
10510	imaging services must be accredited by the Joint Commission on
10511	Accreditation of Healthcare Organizations, the American College
10512	of Radiology, or the Accreditation Association for Ambulatory
10513	Health Care, within 1 year after licensure. However, a clinic
10514	may request a single, 6-month extension if it provides evidence
10515	to the agency establishing that, for good cause shown, such
10516	clinic can not be accredited within 1 year after licensure, and
10517	that such accreditation will be completed within the 6-month
10518	extension. After obtaining accreditation as required by this
10519	subsection, each such clinic must maintain accreditation as a
10520	condition of renewal of its license.
10521	(b)  The agency may deny the application or revoke the
10522	license of any entity formed for the purpose of avoiding
10523	compliance with the accreditation provisions of this subsection
10524	and whose principals were previously principals of an entity
10525	that was unable to meet the accreditation requirements within
10526	the specified timeframes. The agency may adopt rules as to the
10527	accreditation of magnetic resonance imaging clinics.
10528	(8)(12)  The agency shall give full faith and credit
10529	pertaining to any past variance and waiver granted to a magnetic
10530	resonance imaging clinic from rule 64-2002, Florida
10531	Administrative Code, by the Department of Health, until
10532	September 2004. After that date, such clinic must request a
10533	variance and waiver from the agency under s. 120.542.
10534	Section 197.  Section 400.994, Florida Statutes, is
10535	repealed.
10536	Section 198.  Section 400.9945, Florida Statutes, is
10537	repealed.
10538	Section 199.  Section 400.995, Florida Statutes, is amended
10539	to read:
10540	400.995  Agency administrative penalties.--
10541	(1)  The agency may deny the application for a license
10542	renewal, revoke or suspend the license, and impose
10543	administrative fines of up to $5,000 per violation for
10544	violations of the requirements of this part or rules of the
10545	agency. In determining if a penalty is to be imposed and in
10546	fixing the amount of the fine, the agency shall consider the
10547	following factors:
10548	(a)  The gravity of the violation, including the
10549	probability that death or serious physical or emotional harm to
10550	a patient will result or has resulted, the severity of the
10551	action or potential harm, and the extent to which the provisions
10552	of the applicable laws or rules were violated.
10553	(b)  Actions taken by the owner, medical director, or
10554	clinic director to correct violations.
10555	(c)  Any previous violations.
10556	(d)  The financial benefit to the clinic of committing or
10557	continuing the violation.
10558	(2)  Each day of continuing violation after the date fixed
10559	for termination of the violation, as ordered by the agency,
10560	constitutes an additional, separate, and distinct violation.
10561	(2)(3)  Any action taken to correct a violation shall be
10562	documented in writing by the owner, medical director, or clinic
10563	director of the clinic and verified through followup visits by
10564	agency personnel. The agency may impose a fine and, in the case
10565	of an owner-operated clinic, revoke and or deny a clinic's
10566	license when a clinic medical director or clinic director
10567	knowingly misrepresents actions taken to correct a violation.
10568	(4)  For fines that are upheld following administrative or
10569	judicial review, the violator shall pay the fine, plus interest
10570	at the rate as specified in s. 55.03, for each day beyond the
10571	date set by the agency for payment of the fine.
10572	(5)  Any unlicensed clinic that continues to operate after
10573	agency notification is subject to a $1,000 fine per day.
10574	(3)(6)  Any licensed clinic whose owner, medical director,
10575	or clinic director concurrently operates an unlicensed clinic
10576	shall be subject to an administrative fine of $5,000 per day.
10577	(7)  Any clinic whose owner fails to apply for a change-of-
10578	ownership license in accordance with s. 400.992 and operates the
10579	clinic under the new ownership is subject to a fine of $5,000.
10580	(4)(8)  The agency, as an alternative to or in conjunction
10581	with an administrative action against a clinic for violations of
10582	this part, part II of chapter 408, and adopted rules, shall make
10583	a reasonable attempt to discuss each violation and recommended
10584	corrective action with the owner, medical director, or clinic
10585	director of the clinic, prior to written notification. The
10586	agency, instead of fixing a period within which the clinic shall
10587	enter into compliance with standards, may request a plan of
10588	corrective action from the clinic which demonstrates a good
10589	faith effort to remedy each violation by a specific date,
10590	subject to the approval of the agency.
10591	(9)  Administrative fines paid by any clinic under this
10592	section shall be deposited into the Health Care Trust Fund.
10593	(5)(10)  If the agency issues a notice of intent to deny a
10594	license application after a temporary license has been issued
10595	pursuant to s. 400.991(3), the temporary license shall expire on
10596	the date of the notice and may not be extended during any
10597	proceeding for administrative or judicial review pursuant to
10598	chapter 120.
10599	Section 200.  Subsection (2) of section 401.265, Florida
10600	Statutes, is amended to read:
10601	401.265  Medical directors.--
10602	(2)  Each licensee medical director shall establish a
10603	quality assurance committee to provide for quality assurance
10604	review of all emergency medical technicians and paramedics
10605	providing basic life support or advanced life support services
10606	for that licensee. The medical director employed by the licensee
10607	or with whom the licensee has a contract shall provide medical
10608	direction and oversight of the licensee's quality assurance
10609	committee operating under his or her supervision. If the medical
10610	director has reasonable belief that conduct by an emergency
10611	medical technician or paramedic may constitute one or more
10612	grounds for discipline as provided by this part, he or she shall
10613	document facts and other information related to the alleged
10614	violation. The medical director shall report to the department
10615	any emergency medical technician or paramedic whom the medical
10616	director reasonably believes to have acted in a manner which
10617	might constitute grounds for disciplinary action. Such a report
10618	of disciplinary concern must include a statement and
10619	documentation of the specific acts of the disciplinary concern.
10620	Within 7 days after receipt of such a report, the department
10621	shall provide the emergency medical technician or paramedic a
10622	copy of the report of the disciplinary concern and documentation
10623	of the specific acts related to the disciplinary concern. If the
10624	department determines that the report is insufficient for
10625	disciplinary action against the emergency medical technician or
10626	paramedic pursuant to s. 401.411, the report shall be expunged
10627	from the record of the emergency medical technician or
10628	paramedic.
10629	Section 201.  Paragraph (b) of subsection (2) of section
10630	402.164, Florida Statutes, is amended to read:
10631	402.164  Legislative intent; definitions.--
10632	(2)  As used in ss. 402.164-402.167, the term:
10633	(b)  "Client" means a client as defined in s. 393.063, s.
10634	394.67, or s. 397.311, or s. 400.960, a forensic client or
10635	client as defined in s. 916.106, a child or youth as defined in
10636	s. 39.01, a child as defined in s. 827.01, a family as defined
10637	in s. 414.0252, a participant as defined in s. 400.551, a
10638	resident as defined in s. 400.402 or s. 400.960, a Medicaid
10639	recipient or recipient as defined in s. 409.901, a child
10640	receiving child care as defined in s. 402.302, a disabled adult
10641	as defined in s. 410.032 or s. 410.603, or a victim as defined
10642	in s. 39.01 or s. 415.102 as each definition applies within its
10643	respective chapter.
10644	Section 202.  Section 408.831, Florida Statutes, is amended
10645	to read:
10646	408.831  Denial, suspension, or revocation of a license,
10647	registration, certificate, or application.--
10648	(1)  In addition to any other remedies provided by law, the
10649	agency may deny each application or suspend or revoke each
10650	license, registration, or certificate of entities regulated or
10651	licensed by it:
10652	(a)  If the applicant, the licensee, or a licensee subject
10653	to this part that shares a common controlling interest with the
10654	applicant registrant, or certificateholder, or, in the case of a
10655	corporation, partnership, or other business entity, if any
10656	officer, director, agent, or managing employee of that business
10657	entity or any affiliated person, partner, or shareholder having
10658	an ownership interest equal to 5 percent or greater in that
10659	business entity, has failed to pay all outstanding fines, liens,
10660	or overpayments assessed by final order of the agency or final
10661	order of the Centers for Medicare and Medicaid Services, not
10662	subject to further appeal, unless a repayment plan is approved
10663	by the agency; or
10664	(b)  For failure to comply with any repayment plan.
10665	(2)  In reviewing any application requesting a change of
10666	ownership or change of the licensee, registrant, or
10667	certificateholder, the transferor shall, prior to agency
10668	approval of the change, repay or make arrangements to repay any
10669	amounts owed to the agency. Should the transferor fail to repay
10670	or make arrangements to repay the amounts owed to the agency,
10671	the issuance of a license, registration, or certificate to the
10672	transferee shall be delayed until repayment or until
10673	arrangements for repayment are made.
10674	(3)  This section provides standards of enforcement
10675	applicable to all entities licensed or regulated by the Agency
10676	for Health Care Administration. This section controls over any
10677	conflicting provisions of chapters 39, 381, 383, 390, 391, 393,
10678	394, 395, 400, 408, 468, 483, and 641, and 765 or rules adopted
10679	pursuant to those chapters.
10680	Section 203.  Paragraph (g) of subsection (2) of section
10681	409.815, Florida Statutes, is amended to read:
10682	409.815  Health benefits coverage; limitations.--
10683	(2)  BENCHMARK BENEFITS.--In order for health benefits
10684	coverage to qualify for premium assistance payments for an
10685	eligible child under ss. 409.810-409.820, the health benefits
10686	coverage, except for coverage under Medicaid and Medikids, must
10687	include the following minimum benefits, as medically necessary.
10688	(g)  Behavioral health services.--
10689	1.  Mental health benefits include:
10690	a.  Inpatient services, limited to not more than 30
10691	inpatient days per contract year for psychiatric admissions, or
10692	residential services in facilities licensed under s.
10693	394.875(6)(8) or s. 395.003 in lieu of inpatient psychiatric
10694	admissions; however, a minimum of 10 of the 30 days shall be
10695	available only for inpatient psychiatric services when
10696	authorized by a physician; and
10697	b.  Outpatient services, including outpatient visits for
10698	psychological or psychiatric evaluation, diagnosis, and
10699	treatment by a licensed mental health professional, limited to a
10700	maximum of 40 outpatient visits each contract year.
10701	2.  Substance abuse services include:
10702	a.  Inpatient services, limited to not more than 7
10703	inpatient days per contract year for medical detoxification only
10704	and 30 days of residential services; and
10705	b.  Outpatient services, including evaluation, diagnosis,
10706	and treatment by a licensed practitioner, limited to a maximum
10707	of 40 outpatient visits per contract year.
10708	Section 204.  Subsection (8) of section 409.905, Florida
10709	Statutes, is amended to read:
10710	409.905  Mandatory Medicaid services.--The agency may make
10711	payments for the following services, which are required of the
10712	state by Title XIX of the Social Security Act, furnished by
10713	Medicaid providers to recipients who are determined to be
10714	eligible on the dates on which the services were provided. Any
10715	service under this section shall be provided only when medically
10716	necessary and in accordance with state and federal law.
10717	Mandatory services rendered by providers in mobile units to
10718	Medicaid recipients may be restricted by the agency. Nothing in
10719	this section shall be construed to prevent or limit the agency
10720	from adjusting fees, reimbursement rates, lengths of stay,
10721	number of visits, number of services, or any other adjustments
10722	necessary to comply with the availability of moneys and any
10723	limitations or directions provided for in the General
10724	Appropriations Act or chapter 216.
10725	(8)  NURSING FACILITY SERVICES.--The agency shall pay for
10726	24-hour-a-day nursing and rehabilitative services for a
10727	recipient in a nursing facility licensed under part II of
10728	chapter 400 or in a rural hospital, as defined in s. 395.602, or
10729	in a Medicare certified skilled nursing facility operated by a
10730	hospital, as defined by s. 395.002(10)(11), that is licensed
10731	under part I of chapter 395, and in accordance with provisions
10732	set forth in s. 409.908(2)(a), which services are ordered by and
10733	provided under the direction of a licensed physician. However,
10734	if a nursing facility has been destroyed or otherwise made
10735	uninhabitable by natural disaster or other emergency and another
10736	nursing facility is not available, the agency must pay for
10737	similar services temporarily in a hospital licensed under part I
10738	of chapter 395 provided federal funding is approved and
10739	available. The agency shall pay only for bed-hold days if the
10740	facility has an occupancy rate of 95 percent or greater. The
10741	agency is authorized to seek any federal waivers to implement
10742	this policy.
10743	Section 205.  Subsection (7) of section 409.907, Florida
10744	Statutes, is amended to read:
10745	409.907  Medicaid provider agreements.--The agency may make
10746	payments for medical assistance and related services rendered to
10747	Medicaid recipients only to an individual or entity who has a
10748	provider agreement in effect with the agency, who is performing
10749	services or supplying goods in accordance with federal, state,
10750	and local law, and who agrees that no person shall, on the
10751	grounds of handicap, race, color, or national origin, or for any
10752	other reason, be subjected to discrimination under any program
10753	or activity for which the provider receives payment from the
10754	agency.
10755	(7)  The agency may require, as a condition of
10756	participating in the Medicaid program and before entering into
10757	the provider agreement, that the provider submit information, in
10758	an initial and any required renewal applications, concerning the
10759	professional, business, and personal background of the provider
10760	and permit an onsite inspection of the provider's service
10761	location by agency staff or other personnel designated by the
10762	agency to perform this function. The agency shall perform a
10763	random onsite inspection, within 60 days after receipt of a
10764	fully complete new provider's application, of the provider's
10765	service location prior to making its first payment to the
10766	provider for Medicaid services to determine the applicant's
10767	ability to provide the services that the applicant is proposing
10768	to provide for Medicaid reimbursement. The agency is not
10769	required to perform an onsite inspection of a provider or
10770	program that is licensed by the agency, that provides services
10771	under waiver programs for home and community-based services, or
10772	that is licensed as a medical foster home by the Department of
10773	Children and Family Services. As a continuing condition of
10774	participation in the Medicaid program, a provider shall
10775	immediately notify the agency of any current or pending
10776	bankruptcy filing. Before entering into the provider agreement,
10777	or as a condition of continuing participation in the Medicaid
10778	program, the agency may also require that Medicaid providers
10779	reimbursed on a fee-for-services basis or fee schedule basis
10780	which is not cost-based, post a surety bond not to exceed
10781	$50,000 or the total amount billed by the provider to the
10782	program during the current or most recent calendar year,
10783	whichever is greater. For new providers, the amount of the
10784	surety bond shall be determined by the agency based on the
10785	provider's estimate of its first year's billing. If the
10786	provider's billing during the first year exceeds the bond
10787	amount, the agency may require the provider to acquire an
10788	additional bond equal to the actual billing level of the
10789	provider. A provider's bond shall not exceed $50,000 if a
10790	physician or group of physicians licensed under chapter 458,
10791	chapter 459, or chapter 460 has a 50 percent or greater
10792	ownership interest in the provider or if the provider is an
10793	assisted living facility licensed under part III of chapter 400.
10794	The bonds permitted by this section are in addition to the bonds
10795	referenced in s. 400.179(2)(4)(d). If the provider is a
10796	corporation, partnership, association, or other entity, the
10797	agency may require the provider to submit information concerning
10798	the background of that entity and of any principal of the
10799	entity, including any partner or shareholder having an ownership
10800	interest in the entity equal to 5 percent or greater, and any
10801	treating provider who participates in or intends to participate
10802	in Medicaid through the entity. The information must include:
10803	(a)  Proof of holding a valid license or operating
10804	certificate, as applicable, if required by the state or local
10805	jurisdiction in which the provider is located or if required by
10806	the Federal Government.
10807	(b)  Information concerning any prior violation, fine,
10808	suspension, termination, or other administrative action taken
10809	under the Medicaid laws, rules, or regulations of this state or
10810	of any other state or the Federal Government; any prior
10811	violation of the laws, rules, or regulations relating to the
10812	Medicare program; any prior violation of the rules or
10813	regulations of any other public or private insurer; and any
10814	prior violation of the laws, rules, or regulations of any
10815	regulatory body of this or any other state.
10816	(c)  Full and accurate disclosure of any financial or
10817	ownership interest that the provider, or any principal, partner,
10818	or major shareholder thereof, may hold in any other Medicaid
10819	provider or health care related entity or any other entity that
10820	is licensed by the state to provide health or residential care
10821	and treatment to persons.
10822	(d)  If a group provider, identification of all members of
10823	the group and attestation that all members of the group are
10824	enrolled in or have applied to enroll in the Medicaid program.
10825	Section 206.  Subsections (9) and (10) of section 440.102,
10826	Florida Statutes, are amended to read:
10827	440.102  Drug-free workplace program requirements.--The
10828	following provisions apply to a drug-free workplace program
10829	implemented pursuant to law or to rules adopted by the Agency
10830	for Health Care Administration:
10831	(9)  DRUG-TESTING STANDARDS FOR LABORATORIES.--
10832	(a)  The requirements of part II of chapter 408 shall apply
10833	to the provision of services that require licensure pursuant to
10834	this section and part II of chapter 408 and to entities licensed
10835	by or applying for such licensure from the agency pursuant to
10836	this section.
10837	(b)(a)  A laboratory may analyze initial or confirmation
10838	test specimens only if:
10839	1.  The laboratory obtains a license under part II of
10840	chapter 408 and s. 112.0455(17). Each applicant for licensure
10841	and each licensee must comply with all requirements of this
10842	section, part II of chapter 408, and applicable rules, except s.
10843	408.810(5)-(10). is licensed and approved by the Agency for
10844	Health Care Administration using criteria established by the
10845	United States Department of Health and Human Services as general
10846	guidelines for modeling the state drug-testing program pursuant
10847	to this section or the laboratory is certified by the United
10848	States Department of Health and Human Services.
10849	2.  The laboratory has written procedures to ensure the
10850	chain of custody.
10851	3.  The laboratory follows proper quality control
10852	procedures, including, but not limited to:
10853	a.  The use of internal quality controls, including the use
10854	of samples of known concentrations which are used to check the
10855	performance and calibration of testing equipment, and periodic
10856	use of blind samples for overall accuracy.
10857	b.  An internal review and certification process for drug
10858	test results, conducted by a person qualified to perform that
10859	function in the testing laboratory.
10860	c.  Security measures implemented by the testing laboratory
10861	to preclude adulteration of specimens and drug test results.
10862	d.  Other necessary and proper actions taken to ensure
10863	reliable and accurate drug test results.
10864	(c)(b)  A laboratory shall disclose to the medical review
10865	officer a written positive confirmed test result report within 7
10866	working days after receipt of the sample. All laboratory reports
10867	of a drug test result must, at a minimum, state:
10868	1.  The name and address of the laboratory that performed
10869	the test and the positive identification of the person tested.
10870	2.  Positive results on confirmation tests only, or
10871	negative results, as applicable.
10872	3.  A list of the drugs for which the drug analyses were
10873	conducted.
10874	4.  The type of tests conducted for both initial tests and
10875	confirmation tests and the minimum cutoff levels of the tests.
10876	5.  Any correlation between medication reported by the
10877	employee or job applicant pursuant to subparagraph (5)(b)2. and
10878	a positive confirmed drug test result.
10879
10880	A report must not disclose the presence or absence of any drug
10881	other than a specific drug and its metabolites listed pursuant
10882	to this section.
10883	(d)(c)  The laboratory shall submit to the Agency for
10884	Health Care Administration a monthly report with statistical
10885	information regarding the testing of employees and job
10886	applicants. The report must include information on the methods
10887	of analysis conducted, the drugs tested for, the number of
10888	positive and negative results for both initial tests and
10889	confirmation tests, and any other information deemed appropriate
10890	by the Agency for Health Care Administration. A monthly report
10891	must not identify specific employees or job applicants.
10892	(10)  RULES.--The Agency for Health Care Administration
10893	shall adopt rules pursuant to s. 112.0455, part II of chapter
10894	408, and criteria established by the United States Department of
10895	Health and Human Services as general guidelines for modeling
10896	drug-free workplace laboratories the state drug-testing program,
10897	concerning, but not limited to:
10898	(a)  Standards for licensing drug-testing laboratories and
10899	suspension and revocation of such licenses.
10900	(b)  Urine, hair, blood, and other body specimens and
10901	minimum specimen amounts that are appropriate for drug testing.
10902	(c)  Methods of analysis and procedures to ensure reliable
10903	drug-testing results, including standards for initial tests and
10904	confirmation tests.
10905	(d)  Minimum cutoff detection levels for each drug or
10906	metabolites of such drug for the purposes of determining a
10907	positive test result.
10908	(e)  Chain-of-custody procedures to ensure proper
10909	identification, labeling, and handling of specimens tested.
10910	(f)  Retention, storage, and transportation procedures to
10911	ensure reliable results on confirmation tests and retests.
10912	Section 207.  Subsections (5), (6), and (7) of section
10913	464.015, Florida Statutes, are renumbered as subsections (6),
10914	(7), and (8), respectively, present subsection (6) is amended,
10915	and a new subsection (5) is added to said section, to read:
10916	464.015  Titles and abbreviations; restrictions; penalty.--
10917	(5)  Only persons who hold valid certificates to practice
10918	as certified registered nurse anesthetists in this state shall
10919	have the right to use the title "Certified Registered Nurse
10920	Anesthetist," the term "anesthetist," and the abbreviation
10921	"C.R.N.A."
10922	(7)(6)  No person shall practice or advertise as, or assume
10923	the title of, "Registered nurse," "Licensed Practical Nurse,"
10924	"Certified Registered Nurse Anesthetist," "anesthetist," or
10925	"Advanced Registered Nurse Practitioner" or use the abbreviation
10926	"R.N.," "L.P.N.," "C.R.N.A.," or "A.R.N.P." or take any other
10927	action that would lead the public to believe that person was
10928	certified as such or is performing nursing services pursuant to
10929	the exception set forth in s. 464.022(8), unless that person is
10930	licensed or certified to practice as such.
10931	Section 208.  Paragraph (a) of subsection (2) of section
10932	464.016, Florida Statutes, is amended to read:
10933	464.016  Violations and penalties.--
10934	(2)  Each of the following acts constitutes a misdemeanor
10935	of the first degree, punishable as provided in s. 775.082 or s.
10936	775.083:
10937	(a)  Using the name or title "Nurse," "Registered Nurse,"
10938	"Licensed Practical Nurse," "Certified Registered Nurse
10939	Anesthetist," "Advanced Registered Nurse Practitioner," or any
10940	other name or title which implies that a person was licensed or
10941	certified as same, unless such person is duly licensed or
10942	certified.
10943	Section 209.  Paragraph (l) of subsection (1) of section
10944	468.505, Florida Statutes, is amended to read:
10945	468.505  Exemptions; exceptions.--
10946	(1)  Nothing in this part may be construed as prohibiting
10947	or restricting the practice, services, or activities of:
10948	(l)  A person employed by a nursing facility exempt from
10949	licensing under s. 395.002(12)(13), or a person exempt from
10950	licensing under s. 464.022.
10951	Section 210.  Subsection (3) is added to section 483.035,
10952	Florida Statutes, to read:
10953	483.035  Clinical laboratories operated by practitioners
10954	for exclusive use; licensure and regulation.--
10955	(3)  The requirements of part II of chapter 408 shall apply
10956	to the provision of services that require licensure pursuant to
10957	this part and part II of chapter 408 and to entities licensed by
10958	or applying for such licensure from the agency pursuant to this
10959	part. However, each applicant for licensure and each licensee is
10960	exempt from s. 408.810(5)-(10).
10961	Section 211.  Subsection (1) of section 483.051, Florida
10962	Statutes, is amended to read:
10963	483.051  Powers and duties of the agency.--The agency shall
10964	adopt rules to implement this part, which rules must include,
10965	but are not limited to, the following:
10966	(1)  LICENSING; QUALIFICATIONS.--The agency shall provide
10967	for biennial licensure of all clinical laboratories meeting the
10968	requirements of this part and shall prescribe the qualifications
10969	necessary for such licensure. A license issued for operating a
10970	clinical laboratory, unless sooner suspended or revoked, expires
10971	on the date set forth by the agency on the face of the license.
10972	Section 212.  Section 483.061, Florida Statutes, is amended
10973	to read:
10974	483.061  Inspection of clinical laboratories.--
10975	(1)  The agency shall ensure that each clinical laboratory
10976	subject to this part is inspected either onsite or offsite when
10977	deemed necessary by the agency, but at least every 2 years, for
10978	the purpose of evaluating the operation, supervision, and
10979	procedures of the facility to ensure compliance with this part.
10980	Collection stations and branch offices may be inspected either
10981	onsite or offsite, when deemed necessary by the agency. The
10982	agency may conduct or cause to be conducted the following
10983	announced or unannounced inspections at any reasonable time:
10984	(a)  An inspection conducted at the direction of the
10985	federal Health Care Financing Administration.
10986	(b)  A licensure inspection.
10987	(c)  A validation inspection.
10988	(d)  a complaint investigation, including a full licensure
10989	investigation with a review of all licensure standards as
10990	outlined in rule. Complaints received by the agency from
10991	individuals, organizations, or other sources are subject to
10992	review and investigation by the agency. If a complaint has been
10993	filed against a laboratory or if a laboratory has a substantial
10994	licensure deficiency, the agency may inspect the laboratory
10995	annually or as the agency considers necessary.
10996	(2) However, For laboratories operated under s. 483.035,
10997	biennial licensure inspections shall be scheduled so as to cause
10998	the least disruption to the practitioner's scheduled patients.
10999	(2)  The right of entry and inspection is extended to any
11000	premises that is maintained as a laboratory without a license,
11001	but such entry or inspection may not be made without the
11002	permission of the owner or person in charge of the laboratory,
11003	unless an inspection warrant as defined in s. 933.20 is first
11004	obtained.
11005	(3)  The agency may shall inspect an out-of-state clinical
11006	laboratory under this section at the expense of the out-of-state
11007	clinical laboratory to determine whether the laboratory meets
11008	the requirements of this part and part II of chapter 408.
11009	(4)  The agency shall accept, in lieu of its own periodic
11010	inspections for licensure, the survey of or inspection by
11011	private accrediting organizations that perform inspections of
11012	clinical laboratories accredited by such organizations,
11013	including postinspection activities required by the agency.
11014	(a)  The agency shall accept inspections performed by such
11015	organizations if the accreditation is not provisional, if such
11016	organizations perform postinspection activities required by the
11017	agency and provide the agency with all necessary inspection and
11018	postinspection reports and information necessary for
11019	enforcement, if such organizations apply standards equal to or
11020	exceeding standards established and approved by the agency, and
11021	if such accrediting organizations are approved by the federal
11022	Health Care Financing Administration to perform such
11023	inspections.
11024	(b)  The agency may conduct complaint investigations made
11025	against laboratories inspected by accrediting organizations.
11026	(c)  The agency may conduct sample validation inspections
11027	of laboratories inspected by accrediting organizations to
11028	evaluate the accreditation process used by an accrediting
11029	organization.
11030	(d)  The agency may conduct a full inspection if an
11031	accrediting survey has not been conducted within the previous 24
11032	months, and the laboratory must pay the appropriate inspection
11033	fee under s. 483.172.
11034	(e)  The agency shall develop, and adopt, by rule, criteria
11035	for accepting inspection and postinspection reports of
11036	accrediting organizations in lieu of conducting a state
11037	licensure inspection.
11038	Section 213.  Section 483.091, Florida Statutes, is amended
11039	to read:
11040	483.091  Clinical laboratory license.--A person may not
11041	conduct, maintain, or operate a clinical laboratory in this
11042	state, except a laboratory that is exempt under s. 483.031,
11043	unless the clinical laboratory has obtained a license from the
11044	agency. A clinical laboratory may not send a specimen drawn
11045	within this state to any clinical laboratory outside the state
11046	for examination unless the out-of-state laboratory has obtained
11047	a license from the agency. A license is valid only for the
11048	person or persons to whom it is issued and may not be sold,
11049	assigned, or transferred, voluntarily or involuntarily, and is
11050	not valid for any premises other than those for which the
11051	license is issued. However, A new license may be secured for the
11052	new location before the actual change, if the contemplated
11053	change complies with this part, part II of chapter 408, and the
11054	applicable rules adopted under this part. Application for a new
11055	clinical laboratory license must be made 60 days before a change
11056	in the ownership of the clinical laboratory.
11057	Section 214.  Section 483.101, Florida Statutes, is amended
11058	to read:
11059	483.101  Application for Clinical laboratory license.--
11060	(1)  An application for a clinical laboratory license must
11061	be made under oath by the owner or director of the clinical
11062	laboratory or by the public official responsible for operating a
11063	state, municipal, or county clinical laboratory or institution
11064	that contains a clinical laboratory, upon forms provided by the
11065	agency.
11066	(2)  Each applicant for licensure must comply with the
11067	following requirements:
11068	(a)  Upon receipt of a completed, signed, and dated
11069	application, the agency shall require background screening, in
11070	accordance with the level 2 standards for screening set forth in
11071	chapter 435, of the managing director or other similarly titled
11072	individual who is responsible for the daily operation of the
11073	laboratory and of the financial officer, or other similarly
11074	titled individual who is responsible for the financial operation
11075	of the laboratory, including billings for patient services. The
11076	applicant must comply with the procedures for level 2 background
11077	screening as set forth in chapter 435, as well as the
11078	requirements of s. 435.03(3).
11079	(b)  The agency may require background screening of any
11080	other individual who is an applicant if the agency has probable
11081	cause to believe that he or she has been convicted of a crime or
11082	has committed any other offense prohibited under the level 2
11083	standards for screening set forth in chapter 435.
11084	(c)  Proof of compliance with the level 2 background
11085	screening requirements of chapter 435 which has been submitted
11086	within the previous 5 years in compliance with any other health
11087	care licensure requirements of this state is acceptable in
11088	fulfillment of the requirements of paragraph (a).
11089	(d)  A provisional license may be granted to an applicant
11090	when each individual required by this section to undergo
11091	background screening has met the standards for the Department of
11092	Law Enforcement background check but the agency has not yet
11093	received background screening results from the Federal Bureau of
11094	Investigation, or a request for a disqualification exemption has
11095	been submitted to the agency as set forth in chapter 435 but a
11096	response has not yet been issued. A license may be granted to
11097	the applicant upon the agency's receipt of a report of the
11098	results of the Federal Bureau of Investigation background
11099	screening for each individual required by this section to
11100	undergo background screening which confirms that all standards
11101	have been met, or upon the granting of a disqualification
11102	exemption by the agency as set forth in chapter 435. Any other
11103	person who is required to undergo level 2 background screening
11104	may serve in his or her capacity pending the agency's receipt of
11105	the report from the Federal Bureau of Investigation. However,
11106	the person may not continue to serve if the report indicates any
11107	violation of background screening standards and a
11108	disqualification exemption has not been requested of and granted
11109	by the agency as set forth in chapter 435.
11110	(e)  Each applicant must submit to the agency, with its
11111	application, a description and explanation of any exclusions,
11112	permanent suspensions, or terminations of the applicant from the
11113	Medicare or Medicaid programs. Proof of compliance with the
11114	requirements for disclosure of ownership and control interests
11115	under the Medicaid or Medicare programs may be accepted in lieu
11116	of this submission.
11117	(f)  Each applicant must submit to the agency a description
11118	and explanation of any conviction of an offense prohibited under
11119	the level 2 standards of chapter 435 by a member of the board of
11120	directors of the applicant, its officers, or any individual
11121	owning 5 percent or more of the applicant. This requirement does
11122	not apply to a director of a not-for-profit corporation or
11123	organization if the director serves solely in a voluntary
11124	capacity for the corporation or organization, does not regularly
11125	take part in the day-to-day operational decisions of the
11126	corporation or organization, receives no remuneration for his or
11127	her services on the corporation or organization's board of
11128	directors, and has no financial interest and has no family
11129	members with a financial interest in the corporation or
11130	organization, provided that the director and the not-for-profit
11131	corporation or organization include in the application a
11132	statement affirming that the director's relationship to the
11133	corporation satisfies the requirements of this paragraph.
11134	(g)  A license may not be granted to an applicant if the
11135	applicant or managing employee has been found guilty of,
11136	regardless of adjudication, or has entered a plea of nolo
11137	contendere or guilty to, any offense prohibited under the level
11138	2 standards for screening set forth in chapter 435, unless an
11139	exemption from disqualification has been granted by the agency
11140	as set forth in chapter 435.
11141	(h)  The agency may deny or revoke licensure if the
11142	applicant:
11143	1.  Has falsely represented a material fact in the
11144	application required by paragraph (e) or paragraph (f), or has
11145	omitted any material fact from the application required by
11146	paragraph (e) or paragraph (f); or
11147	2.  Has had prior action taken against the applicant under
11148	the Medicaid or Medicare program as set forth in paragraph (e).
11149	(i)  An application for license renewal must contain the
11150	information required under paragraphs (e) and (f).
11151	(3)  A license must be issued authorizing the performance
11152	of one or more clinical laboratory procedures or one or more
11153	tests on each specialty or subspecialty. A separate license is
11154	required of all laboratories maintained on separate premises
11155	even if the laboratories are operated under the same management.
11156	Upon receipt of a request for an application for a clinical
11157	laboratory license, the agency shall provide to the applicant a
11158	copy of the rules relating to licensure and operations
11159	applicable to the laboratory for which licensure is sought.
11160	Section 215.  Section 483.106, Florida Statutes, is amended
11161	to read:
11162	483.106  Application for a certificate of exemption.--An
11163	application for a certificate of exemption must be made under
11164	oath by the owner or director of a clinical laboratory that
11165	performs only waived tests as defined in s. 483.041. A
11166	certificate of exemption authorizes a clinical laboratory to
11167	perform waived tests. Laboratories maintained on separate
11168	premises and operated under the same management may apply for a
11169	single certificate of exemption or multiple certificates of
11170	exemption. The agency shall, by rule, specify the process for
11171	biennially issuing certificates of exemption. Sections 483.011,
11172	483.021, 483.031, 483.041, 483.172, and 483.23, and 483.25 apply
11173	to a clinical laboratory that obtains a certificate of exemption
11174	under this section.
11175	Section 216.  Section 483.111, Florida Statutes, is amended
11176	to read:
11177	483.111  Limitations on licensure.--A license may be issued
11178	to a clinical laboratory to perform only those clinical
11179	laboratory procedures and tests that are within the specialties
11180	or subspecialties in which the clinical laboratory personnel are
11181	qualified. A license may not be issued unless the agency
11182	determines that the clinical laboratory is adequately staffed
11183	and equipped to operate in conformity with the requirements of
11184	this part, part II of chapter 408, and applicable the rules
11185	adopted under this part.
11186	Section 217.  Section 483.131, Florida Statutes, is
11187	repealed.
11188	Section 218.  Subsections (1) and (2) of section 483.172,
11189	Florida Statutes, are amended to read:
11190	483.172  License fees.--
11191	(1)  In accordance with s. 408.805, an applicant or a
11192	licensee shall pay a fee for each license application submitted
11193	under this part, part II of chapter 408, and applicable rules.
11194	The agency shall collect fees for all licenses issued under this
11195	part. Each fee is due at the time of application and must be
11196	payable to the agency to be deposited in the Health Care Trust
11197	Fund administered by the agency.
11198	(2)  The biennial license fee schedule is as follows,
11199	unless modified by rule:
11200	(a)  If a laboratory performs not more than 2,000 tests
11201	annually, the fee is $400.
11202	(b)  If a laboratory performs not more than 3 categories of
11203	procedures with a total annual volume of more than 2,000 but no
11204	more than 10,000 tests, the license fee is $965.
11205	(c)  If a laboratory performs at least 4 categories of
11206	procedures with a total annual volume of not more than 10,000
11207	tests, the license fee is $1,294.
11208	(d)  If a laboratory performs not more than 3 categories of
11209	procedures with a total annual volume of more than 10,000 but
11210	not more than 25,000 tests, the license fee is $1,592.
11211	(e)  If a laboratory performs at least 4 categories of
11212	procedures with a total annual volume of more than 10,000 but
11213	not more than 25,000 tests, the license fee is $2,103.
11214	(f)  If a laboratory performs a total of more than 25,000
11215	but not more than 50,000 tests annually, the license fee is
11216	$2,364.
11217	(g)  If a laboratory performs a total of more than 50,000
11218	but not more than 75,000 tests annually, the license fee is
11219	$2,625.
11220	(h)  If a laboratory performs a total of more than 75,000
11221	but not more than 100,000 tests annually, the license fee is
11222	$2,886.
11223	(i)  If a laboratory performs a total of more than 100,000
11224	but not more than 500,000 tests annually, the license fee is
11225	$3,397.
11226	(j)  If a laboratory performs a total of more than 500,000
11227	but not more than 1 million tests annually, the license fee is
11228	$3,658.
11229	(k)  If a laboratory performs a total of more than 1
11230	million tests annually, the license fee is $3,919.
11231	Section 219.  Section 483.201, Florida Statutes, is amended
11232	to read:
11233	483.201  Grounds for disciplinary action against clinical
11234	laboratories.--In addition to the requirements of part II of
11235	chapter 408, the following acts constitute grounds for which a
11236	disciplinary action specified in s. 483.221 may be taken against
11237	a clinical laboratory:
11238	(1)  Making a fraudulent statement on an application for a
11239	clinical laboratory license or any other document required by
11240	the agency.
11241	(1)(2)  Permitting unauthorized persons to perform
11242	technical procedures or to issue reports.
11243	(2)(3)  Demonstrating incompetence or making consistent
11244	errors in the performance of clinical laboratory examinations
11245	and procedures or erroneous reporting.
11246	(3)(4)  Performing a test and rendering a report thereon to
11247	a person not authorized by law to receive such services.
11248	(4)(5)  Knowingly having professional connection with or
11249	knowingly lending the use of the name of the licensed clinical
11250	laboratory or its director to an unlicensed clinical laboratory.
11251	(5)(6)  Violating or aiding and abetting in the violation
11252	of any provision of this part or the rules adopted under this
11253	part.
11254	(6)(7)  Failing to file any report required by the
11255	provisions of this part or the rules adopted under this part.
11256	(7)(8)  Reporting a test result for a clinical specimen if
11257	the test was not performed on the clinical specimen.
11258	(8)(9)  Performing and reporting tests in a specialty or
11259	subspecialty in which the laboratory is not licensed.
11260	(9)(10)  Knowingly advertising false services or
11261	credentials.
11262	(10)(11)  Failing to correct deficiencies within the time
11263	required by the agency.
11264	Section 220.  Section 483.221, Florida Statutes, is amended
11265	to read:
11266	483.221  Administrative fines penalties.--
11267	(1)(a)  In accordance with part II of chapter 408, the
11268	agency may deny, suspend, revoke, annul, limit, or deny renewal
11269	of a license or impose an administrative fine, not to exceed
11270	$1,000 per violation, for the violation of any provision of this
11271	part or rules adopted under this part. Each day of violation
11272	constitutes a separate violation and is subject to a separate
11273	fine.
11274	(2)(b)  In determining the penalty to be imposed for a
11275	violation, as provided in subsection (1) paragraph (a), the
11276	following factors must be considered:
11277	(a)1.  The severity of the violation, including the
11278	probability that death or serious harm to the health or safety
11279	of any person will result or has resulted; the severity of the
11280	actual or potential harm; and the extent to which the provisions
11281	of this part were violated.
11282	(b)2.  Actions taken by the licensee to correct the
11283	violation or to remedy complaints.
11284	(c)3.  Any previous violation by the licensee.
11285	(d)4.  The financial benefit to the licensee of committing
11286	or continuing the violation.
11287	(c)  All amounts collected under this section must be
11288	deposited into the Health Care Trust Fund administered by the
11289	agency.
11290	(2)  The agency may issue an emergency order immediately
11291	suspending, revoking, annulling, or limiting a license if it
11292	determines that any condition in the licensed facility presents
11293	a clear and present danger to public health or safety.
11294	Section 221.  Section 483.23, Florida Statutes, is amended
11295	to read:
11296	483.23  Offenses; criminal penalties.--
11297	(1)(a)  It is unlawful for any person to:
11298	1.  Operate, maintain, direct, or engage in the business of
11299	operating a clinical laboratory unless she or he has obtained a
11300	clinical laboratory license from the agency or is exempt under
11301	s. 483.031.
11302	1.2.  Conduct, maintain, or operate a clinical laboratory,
11303	other than an exempt laboratory or a laboratory operated under
11304	s. 483.035, unless the clinical laboratory is under the direct
11305	and responsible supervision and direction of a person licensed
11306	under part III of this chapter.
11307	2.3.  Allow any person other than an individual licensed
11308	under part III of this chapter to perform clinical laboratory
11309	procedures, except in the operation of a laboratory exempt under
11310	s. 483.031 or a laboratory operated under s. 483.035.
11311	3.4.  Violate or aid and abet in the violation of any
11312	provision of this part or the rules adopted under this part.
11313	(b)  The performance of any act specified in paragraph (a)
11314	constitutes a misdemeanor of the second degree, punishable as
11315	provided in s. 775.082 or s. 775.083.
11316	(2)  Any use or attempted use of a forged license under
11317	this part or part IV III of this chapter constitutes the crime
11318	of forgery.
11319	Section 222.  Section 483.25, Florida Statutes, is
11320	repealed.
11321	Section 223.  Section 483.291, Florida Statutes, is amended
11322	to read:
11323	483.291  Powers and duties of the agency; rules.--The
11324	agency shall adopt rules to implement this part and part II of
11325	chapter 408, which rules must include the following:
11326	(1)  LICENSING STANDARDS.--The agency shall license all
11327	multiphasic health testing centers meeting the requirements of
11328	this part and shall prescribe standards necessary for licensure.
11329	(2)  FEES.-- In accordance with s. 408.805, an applicant or
11330	a licensee shall pay a fee for each license application
11331	submitted under this part, part II of chapter 408, and
11332	applicable rules. The agency shall establish annual fees, which
11333	shall be reasonable in amount, for licensing of centers. The
11334	fees must be sufficient in amount to cover the cost of licensing
11335	and inspecting centers.
11336	(a)  The annual licensure fee is due at the time of
11337	application and is payable to the agency to be deposited in the
11338	Health Care Trust Fund administered by the agency. The license
11339	fee must be not less than $600 $300 or more than $2,000 per
11340	biennium $1,000.
11341	(b)  The fee for late filing of an application for license
11342	renewal is $200 and is in addition to the licensure fee due for
11343	renewing the license.
11344	(3)  ANNUAL LICENSING.--The agency shall provide for annual
11345	licensing of centers. Any center that fails to pay the proper
11346	fee or otherwise fails to qualify by the date of expiration of
11347	its license is delinquent, and its license is automatically
11348	canceled without notice or further proceeding. Upon cancellation
11349	of its license under this subsection, a center may have its
11350	license reinstated only upon application and qualification as
11351	provided for initial applicants and upon payment of all
11352	delinquent fees.
11353	(3)(4)  STANDARDS OF PERFORMANCE.--The agency shall
11354	prescribe standards for the performance of health testing
11355	procedures.
11356	(4)(5)  CONSTRUCTION OF CENTERS.--The agency may adopt
11357	rules to ensure that centers comply with all local, county,
11358	state, and federal standards for the construction, renovation,
11359	maintenance, or repair of centers, which standards must ensure
11360	the conduct and operation of the centers in a manner that will
11361	protect the public health.
11362	(5)(6)  SAFETY AND SANITARY CONDITIONS WITHIN THE CENTER
11363	AND ITS SURROUNDINGS.--The agency shall establish standards
11364	relating to safety and sanitary conditions within the center and
11365	its surroundings, including water supply; sewage; the handling
11366	of specimens; identification, segregation, and separation of
11367	biohazardous waste as required by s. 381.0098; storage of
11368	chemicals; workspace; firesafety; and general measures, which
11369	standards must ensure the protection of the public health. The
11370	agency shall determine compliance by a multiphasic health
11371	testing center with the requirements of s. 381.0098 by verifying
11372	that the center has obtained all required permits.
11373	(6)(7)  EQUIPMENT.--The agency shall establish minimum
11374	standards for center equipment essential to the proper conduct
11375	and operation of the center.
11376	(7)(8)  PERSONNEL.--The agency shall prescribe minimum
11377	qualifications for center personnel. A center may employ as a
11378	medical assistant a person who has at least one of the following
11379	qualifications:
11380	(a)  Prior experience of not less than 6 months as a
11381	medical assistant in the office of a licensed medical doctor or
11382	osteopathic physician or in a hospital, an ambulatory surgical
11383	center, a home health agency, or a health maintenance
11384	organization.
11385	(b)  Certification and registration by the American Medical
11386	Technologists Association or other similar professional
11387	association approved by the agency.
11388	(c)  Prior employment as a medical assistant in a licensed
11389	center for at least 6 consecutive months at some time during the
11390	preceding 2 years.
11391	Section 224.  Section 483.294, Florida Statutes, is amended
11392	to read:
11393	483.294  Inspection of centers.--The agency shall, at least
11394	once annually, inspect the premises and operations of all
11395	centers subject to licensure under this part, without prior
11396	notice to the centers, for the purpose of studying and
11397	evaluating the operation, supervision, and procedures of such
11398	facilities, to determine their compliance with agency standards
11399	and to determine their effect upon the health and safety of the
11400	people of this state.
11401	Section 225.  Section 483.30, Florida Statutes, is amended
11402	to read:
11403	483.30  Licensing of centers.--The requirements of part II
11404	of chapter 408 shall apply to the provision of services that
11405	require licensure pursuant to this part and part II of chapter
11406	408 and to entities licensed by or applying for such licensure
11407	from the agency pursuant to this part. However, each applicant
11408	for licensure and each licensee is exempt from s. 408.810(5)-
11409	(10).
11410	(1)  A person may not conduct, maintain, or operate a
11411	multiphasic health testing center in this state without
11412	obtaining a multiphasic health testing center license from the
11413	agency. The license is valid only for the person or persons to
11414	whom it is issued and may not be sold, assigned, or transferred,
11415	voluntarily or involuntarily. A license is not valid for any
11416	premises other than the center for which it is issued. However,
11417	a new license may be secured for the new location for a fixed
11418	center before the actual change, if the contemplated change is
11419	in compliance with this part and the rules adopted under this
11420	part. A center must be relicensed if a change of ownership
11421	occurs. Application for relicensure must be made 60 days before
11422	the change of ownership.
11423	(2)  Each applicant for licensure must comply with the
11424	following requirements:
11425	(a)  Upon receipt of a completed, signed, and dated
11426	application, the agency shall require background screening, in
11427	accordance with the level 2 standards for screening set forth in
11428	chapter 435, of the managing employee, or other similarly titled
11429	individual who is responsible for the daily operation of the
11430	center, and of the financial officer, or other similarly titled
11431	individual who is responsible for the financial operation of the
11432	center, including billings for patient services. The applicant
11433	must comply with the procedures for level 2 background screening
11434	as set forth in chapter 435, as well as the requirements of s.
11435	435.03(3).
11436	(b)  The agency may require background screening of any
11437	other individual who is an applicant if the agency has probable
11438	cause to believe that he or she has been convicted of a crime or
11439	has committed any other offense prohibited under the level 2
11440	standards for screening set forth in chapter 435.
11441	(c)  Proof of compliance with the level 2 background
11442	screening requirements of chapter 435 which has been submitted
11443	within the previous 5 years in compliance with any other health
11444	care licensure requirements of this state is acceptable in
11445	fulfillment of the requirements of paragraph (a).
11446	(d)  A provisional license may be granted to an applicant
11447	when each individual required by this section to undergo
11448	background screening has met the standards for the Department of
11449	Law Enforcement background check, but the agency has not yet
11450	received background screening results from the Federal Bureau of
11451	Investigation, or a request for a disqualification exemption has
11452	been submitted to the agency as set forth in chapter 435 but a
11453	response has not yet been issued. A license may be granted to
11454	the applicant upon the agency's receipt of a report of the
11455	results of the Federal Bureau of Investigation background
11456	screening for each individual required by this section to
11457	undergo background screening which confirms that all standards
11458	have been met, or upon the granting of a disqualification
11459	exemption by the agency as set forth in chapter 435. Any other
11460	person who is required to undergo level 2 background screening
11461	may serve in his or her capacity pending the agency's receipt of
11462	the report from the Federal Bureau of Investigation. However,
11463	the person may not continue to serve if the report indicates any
11464	violation of background screening standards and a
11465	disqualification exemption has not been requested of and granted
11466	by the agency as set forth in chapter 435.
11467	(e)  Each applicant must submit to the agency, with its
11468	application, a description and explanation of any exclusions,
11469	permanent suspensions, or terminations of the applicant from the
11470	Medicare or Medicaid programs. Proof of compliance with the
11471	requirements for disclosure of ownership and control interests
11472	under the Medicaid or Medicare programs may be accepted in lieu
11473	of this submission.
11474	(f)  Each applicant must submit to the agency a description
11475	and explanation of any conviction of an offense prohibited under
11476	the level 2 standards of chapter 435 by a member of the board of
11477	directors of the applicant, its officers, or any individual
11478	owning 5 percent or more of the applicant. This requirement does
11479	not apply to a director of a not-for-profit corporation or
11480	organization if the director serves solely in a voluntary
11481	capacity for the corporation or organization, does not regularly
11482	take part in the day-to-day operational decisions of the
11483	corporation or organization, receives no remuneration for his or
11484	her services on the corporation or organization's board of
11485	directors, and has no financial interest and has no family
11486	members with a financial interest in the corporation or
11487	organization, provided that the director and the not-for-profit
11488	corporation or organization include in the application a
11489	statement affirming that the director's relationship to the
11490	corporation satisfies the requirements of this paragraph.
11491	(g)  A license may not be granted to an applicant if the
11492	applicant or managing employee has been found guilty of,
11493	regardless of adjudication, or has entered a plea of nolo
11494	contendere or guilty to, any offense prohibited under the level
11495	2 standards for screening set forth in chapter 435, unless an
11496	exemption from disqualification has been granted by the agency
11497	as set forth in chapter 435.
11498	(h)  The agency may deny or revoke licensure if the
11499	applicant:
11500	1.  Has falsely represented a material fact in the
11501	application required by paragraph (e) or paragraph (f), or has
11502	omitted any material fact from the application required by
11503	paragraph (e) or paragraph (f); or
11504	2.  Has had prior action taken against the applicant under
11505	the Medicaid or Medicare program as set forth in paragraph (e).
11506	(i)  An application for license renewal must contain the
11507	information required under paragraphs (e) and (f).
11508	Section 226.  Section 483.302, Florida Statutes, is amended
11509	to read:
11510	483.302  Application for license.--
11511	(1)  Application for a license as required by s. 483.30
11512	must be made to the agency on forms furnished by it and must be
11513	accompanied by the appropriate license fee.
11514	(2)  The application for a license must shall contain:
11515	(1)(a)  A determination as to whether the facility will be
11516	fixed or mobile and the location for a fixed facility.
11517	(b)  The name and address of the owner if an individual; if
11518	the owner is a firm, partnership, or association, the name and
11519	address of every member thereof; if the owner is a corporation,
11520	its name and address and the name and address of its medical
11521	director and officers and of each person having at least a 10
11522	percent interest in the corporation.
11523	(2)(c)  The name of any person whose name is required on
11524	the application under the provisions of paragraph (b) and who
11525	owns at least a 10 percent interest in any professional service,
11526	firm, association, partnership, or corporation providing goods,
11527	leases, or services to the center for which the application is
11528	made, and the name and address of the professional service,
11529	firm, association, partnership, or corporation in which such
11530	interest is held.
11531	(d)  The name by which the facility is to be known.
11532	(3)(e)  The name, address, and Florida physician's license
11533	number of the medical director.
11534	Section 227.  Section 483.311, Florida Statutes, is
11535	repealed.
11536	Section 228.  Subsections (2) through (8) of section
11537	483.317, Florida Statutes, are renumbered as subsections (1)
11538	through (7), respectively, and present subsection (1) is amended
11539	to read:
11540	483.317  Grounds for disciplinary action against
11541	centers.--The following acts constitute grounds for which a
11542	disciplinary action specified in s. 483.32 may be taken against
11543	a center:
11544	(1)  Making a fraudulent statement on an application for a
11545	license or on any other document required by the agency pursuant
11546	to this part.
11547	Section 229.  Section 483.32, Florida Statutes, is amended
11548	to read:
11549	483.32  Administrative fines penalties.--
11550	(1)(a)  The agency may deny, suspend, revoke, annul, limit,
11551	or deny renewal of a license or impose an administrative fine,
11552	not to exceed $500 per violation, for the violation of any
11553	provision of this part, part II of chapter 408, or applicable
11554	rules adopted under this part. Each day of violation constitutes
11555	a separate violation and is subject to a separate fine.
11556	(2)(b)  In determining the amount of the fine to be levied
11557	for a violation, as provided in subsection (1) paragraph (a),
11558	the following factors shall be considered:
11559	(a)1.  The severity of the violation, including the
11560	probability that death or serious harm to the health or safety
11561	of any person will result or has resulted; the severity of the
11562	actual or potential harm; and the extent to which the provisions
11563	of this part were violated.
11564	(b)2.  Actions taken by the licensee to correct the
11565	violation or to remedy complaints.
11566	(c)3.  Any previous violation by the licensee.
11567	(d)4.  The financial benefit to the licensee of committing
11568	or continuing the violation.
11569	(c)  All amounts collected under this section must be
11570	deposited into the Health Care Trust Fund administered by the
11571	agency.
11572	(2)  The agency may issue an emergency order immediately
11573	suspending, revoking, annulling, or limiting a license when it
11574	determines that any condition in the licensed facility presents
11575	a clear and present danger to public health and safety.
11576	Section 230.  Subsections (2) and (3) of section 483.322,
11577	Florida Statutes, are renumbered as subsections (1) and (2),
11578	respectively, and present subsection (1) of said section is
11579	amended to read:
11580	483.322  Offenses.--It is unlawful for any person to:
11581	(1)  Operate, maintain, direct, or engage in the business
11582	of operating a multiphasic health testing center unless the
11583	person has obtained a license for the center.
11584	Section 231.  Section 483.328, Florida Statutes, is
11585	repealed.
11586	Section 232.  Subsection (2) of section 765.541, Florida
11587	Statutes, is amended to read:
11588	765.541  Certification of organizations engaged in the
11589	practice of cadaveric organ and tissue procurement.--The Agency
11590	for Health Care Administration shall:
11591	(2)  Adopt rules that set forth appropriate standards and
11592	guidelines for the program in accordance with ss. 765.541-
11593	765.546 and part II of chapter 408. These standards and
11594	guidelines must be substantially based on the existing laws of
11595	the Federal Government and this state and the existing standards
11596	and guidelines of the United Network for Organ Sharing (UNOS),
11597	the American Association of Tissue Banks (AATB), the South-
11598	Eastern Organ Procurement Foundation (SEOPF), the North American
11599	Transplant Coordinators Organization (NATCO), and the Eye Bank
11600	Association of America (EBAA). In addition, the Agency for
11601	Health Care Administration shall, before adopting these
11602	standards and guidelines, seek input from all organ procurement
11603	organizations, tissue banks, and eye banks based in this state;
11604	Section 233.  Subsection (1) of section 765.542, Florida
11605	Statutes, is amended to read:
11606	765.542  Certification of organ procurement organizations,
11607	tissue banks, and eye banks.--
11608	(1)  The requirements of part II of chapter 408 shall apply
11609	to the provision of services that require licensure pursuant to
11610	ss. 765.541-765.546 and part II of chapter 408 and to entities
11611	licensed or certified by or applying for such licensure or
11612	certification from the Agency for Health Care Administration
11613	pursuant to ss. 765.541-765.546. However, each applicant for
11614	licensure or certification and each certificateholder is exempt
11615	from s. 408.810(5)-(10). An organization, agency, or other
11616	entity may not engage in the practice of organ procurement in
11617	this state without being designated as an organ procurement
11618	organization by the secretary of the United States Department of
11619	Health and Human Services and being appropriately certified by
11620	the Agency for Health Care Administration. As used in this
11621	subsection, the term "procurement" includes the retrieval,
11622	processing, or distribution of human organs. A physician or
11623	organ procurement organization based outside this state is
11624	exempt from these certification requirements if:
11625	(a)  The organs are procured for an out-of-state patient
11626	who is listed on, or referred through, the United Network for
11627	Organ Sharing System; and
11628	(b)  The organs are procured through an agreement of an
11629	organ procurement organization certified by the state.
11630	Section 234.  Section 765.544, Florida Statutes, is amended
11631	to read:
11632	765.544  Fees; Florida Organ and Tissue Donor Education and
11633	Procurement Trust Fund.--
11634	(1)  In accordance with s. 408.805, an applicant or a
11635	certificateholder shall pay a fee for each application submitted
11636	under this part, part II of chapter 408, and applicable rules.
11637	The amount of the fee shall be as follows unless modified by
11638	rule: The Agency for Health Care Administration shall collect
11639	(a)  An initial application fee of $1,000 from organ
11640	procurement organizations and tissue banks and $500 from eye
11641	banks. The fee must be submitted with each application for
11642	initial certification and is nonrefundable.
11643	(b)(2)  The Agency for Health Care Administration shall
11644	assess Annual fees to be used, in the following order of
11645	priority, for the certification program, the advisory board,
11646	maintenance of the organ and tissue donor registry, and the
11647	organ and tissue donor education program in the following
11648	amounts, which may not exceed $35,000 per organization:
11649	1.(a)  Each general organ procurement organization shall
11650	pay the greater of $1,000 or 0.25 percent of its total revenues
11651	produced from procurement activity in this state by the
11652	certificateholder during its most recently completed fiscal year
11653	or operational year.
11654	2.(b)  Each bone and tissue procurement agency or bone and
11655	tissue bank shall pay the greater of $1,000 or 0.25 percent of
11656	its total revenues from procurement and processing activity in
11657	this state by the certificateholder during its most recently
11658	completed fiscal year or operational year.
11659	3.(c)  Each eye bank shall pay the greater of $500 or 0.25
11660	percent of its total revenues produced from procurement activity
11661	in this state by the certificateholder during its most recently
11662	completed fiscal year or operational year.
11663	(2)(3)  The Agency for Health Care Administration shall
11664	specify provide by rule the for administrative penalties for the
11665	purpose of ensuring adherence to the standards of quality and
11666	practice required by this chapter, part II of chapter 408, and
11667	applicable rules of the agency for continued certification.
11668	(3)(4)(a)  Proceeds from fees, administrative penalties,
11669	and surcharges collected pursuant to this section subsections
11670	(2) and (3) must be deposited into the Florida Organ and Tissue
11671	Donor Education and Procurement Trust Fund created by s.
11672	765.52155.
11673	(b)  Moneys deposited in the trust fund pursuant to this
11674	section must be used exclusively for the implementation,
11675	administration, and operation of the certification program and
11676	the advisory board, for maintaining the organ and tissue donor
11677	registry, and for organ and tissue donor education.
11678	(4)(5)  As used in this section, the term "procurement
11679	activity in this state" includes the bringing into this state
11680	for processing, storage, distribution, or transplantation of
11681	organs or tissues that are initially procured in another state
11682	or country.
11683	Section 235.  Subsection (4) of section 766.118, Florida
11684	Statutes, is amended to read:
11685	766.118  Determination of noneconomic damages.--
11686	(4)  LIMITATION ON NONECONOMIC DAMAGES FOR NEGLIGENCE OF
11687	PRACTITIONERS PROVIDING EMERGENCY SERVICES AND
11688	CARE.--Notwithstanding subsections (2) and (3), with respect to
11689	a cause of action for personal injury or wrongful death arising
11690	from medical negligence of practitioners providing emergency
11691	services and care, as defined in s. 395.002(9)(10), or providing
11692	services as provided in s. 401.265, or providing services
11693	pursuant to obligations imposed by 42 U.S.C. s. 1395dd to
11694	persons with whom the practitioner does not have a then-existing
11695	health care patient-practitioner relationship for that medical
11696	condition:
11697	(a)  Regardless of the number of such practitioner
11698	defendants, noneconomic damages shall not exceed $150,000 per
11699	claimant.
11700	(b)  Notwithstanding paragraph (a), the total noneconomic
11701	damages recoverable by all claimants from all such practitioners
11702	shall not exceed $300,000.
11703
11704	The limitation provided by this subsection applies only to
11705	noneconomic damages awarded as a result of any act or omission
11706	of providing medical care or treatment, including diagnosis that
11707	occurs prior to the time the patient is stabilized and is
11708	capable of receiving medical treatment as a nonemergency
11709	patient, unless surgery is required as a result of the emergency
11710	within a reasonable time after the patient is stabilized, in
11711	which case the limitation provided by this subsection applies to
11712	any act or omission of providing medical care or treatment which
11713	occurs prior to the stabilization of the patient following the
11714	surgery.
11715	Section 236.  Section 766.316, Florida Statutes, is amended
11716	to read:
11717	766.316  Notice to obstetrical patients of participation in
11718	the plan.--Each hospital with a participating physician on its
11719	staff and each participating physician, other than residents,
11720	assistant residents, and interns deemed to be participating
11721	physicians under s. 766.314(4)(c), under the Florida Birth-
11722	Related Neurological Injury Compensation Plan shall provide
11723	notice to the obstetrical patients as to the limited no-fault
11724	alternative for birth-related neurological injuries. Such notice
11725	shall be provided on forms furnished by the association and
11726	shall include a clear and concise explanation of a patient's
11727	rights and limitations under the plan. The hospital or the
11728	participating physician may elect to have the patient sign a
11729	form acknowledging receipt of the notice form. Signature of the
11730	patient acknowledging receipt of the notice form raises a
11731	rebuttable presumption that the notice requirements of this
11732	section have been met. Notice need not be given to a patient
11733	when the patient has an emergency medical condition as defined
11734	in s. 395.002(8)(9)(b) or when notice is not practicable.
11735	Section 237.  Paragraph (b) of subsection (2) of section
11736	812.014, Florida Statutes, is amended to read:
11737	812.014  Theft.--
11738	(2)
11739	(b)1.  If the property stolen is valued at $20,000 or more,
11740	but less than $100,000;
11741	2.  The property stolen is cargo valued at less than
11742	$50,000 that has entered the stream of interstate or intrastate
11743	commerce from the shipper's loading platform to the consignee's
11744	receiving dock; or
11745	3.  The property stolen is emergency medical equipment,
11746	valued at $300 or more, that is taken from a facility licensed
11747	under chapter 395 or from an aircraft or vehicle permitted under
11748	chapter 401,
11749
11750	the offender commits grand theft in the second degree,
11751	punishable as a felony of the second degree, as provided in s.
11752	775.082, s. 775.083, or s. 775.084. Emergency medical equipment
11753	means mechanical or electronic apparatus used to provide
11754	emergency services and care as defined in s. 395.002(9)(10) or
11755	to treat medical emergencies.
11756	Section 238.  In case of conflict between the provisions of
11757	part II of chapter 408, Florida Statutes, and the authorizing
11758	statutes governing the licensure of health care providers by the
11759	Agency for Health Care Administration found in chapter 112,
11760	chapter 383, chapter 390, chapter 394, chapter 395, chapter 400,
11761	chapter 440, chapter 483, and chapter 765, Florida Statutes, the
11762	provisions of part II of chapter 408, Florida Statutes, shall
11763	prevail.
11764	Section 239.  Rules adopted by the Department of Elderly
11765	Affairs under parts III, V, VI, and VII of chapter 400, Florida
11766	Statutes, shall be transferred by a type two transfer, as
11767	defined in s. 20.06, Florida Statutes, to the Agency for Health
11768	Care Administration.
11769	Section 240.  Between October 1, 2005, and September 30,
11770	2006, inclusive, the Agency for Health Care Administration may
11771	issue any license for less than a 2-year period by charging a
11772	prorated licensure fee and specifying a different renewal date
11773	than would otherwise be required for biennial licensure.
11774	Section 241.  This act shall take effect October 1, 2005.

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