HB 7139

1	A bill to be entitled
2	An act relating to emergency management; amending s.
3	252.355, F.S.; specifying additional entities and agencies
4	that are required to provide registration information to
5	persons with special needs for purposes of inclusion
6	within the registry of persons with special needs
7	maintained by local emergency management agencies;
8	providing that the Department of Community Affairs shall
9	be the designated lead agency responsible for community
10	education and outreach to the general public, including
11	persons with special needs, regarding registration as a
12	person with special needs, special needs shelters, and
13	general information regarding shelter stays; providing
14	that a person with special needs shall be allowed to bring
15	his or her service animal into a special needs shelter;
16	revising provisions with respect to the required
17	notification of residential utility customers of the
18	availability of the special needs registration program;
19	providing that special needs shelter roster information
20	shall be provided to local law enforcement agencies upon
21	request; creating s. 252.3568, F.S.; requiring the
22	Division of Emergency Management to address strategies for
23	the evacuation of persons with pets in the shelter
24	component of the state comprehensive emergency management
25	plan; providing for the inclusion of the requirement for
26	similar strategies within local comprehensive emergency
27	management plans; requiring the Department of Agriculture
28	and Consumer Services to provide specified assistance to
29	the division; creating s. 252.357, F.S., requiring the
30	Florida Comprehensive Emergency Management Plan to permit
31	the Agency for Health Care Administration to make initial
32	contact with each nursing home and assisted living
33	facility in a disaster area; requiring the agency to
34	annually publish an emergency telephone number that may be
35	used by nursing homes and assisted living facilities to
36	contact the agency; amending s. 252.385, F.S., relating to
37	public shelter space; requiring the Division of Emergency
38	Management of the Department of Community Affairs to
39	biennially prepare and submit a statewide emergency
40	shelter plan to the Governor and the Cabinet for approval;
41	providing plan requirements; requiring the Department of
42	Health to provide specified assistance to the division;
43	revising those facilities which are excluded as being
44	suitable for use as public hurricane evacuation shelters;
45	requiring local emergency management agencies to
46	coordinate with public facilities to determine readiness
47	prior to activation; amending s. 381.0303, F.S.; providing
48	for the operation and closure of special needs shelters;
49	providing that local Children's Medical Services offices
50	shall assume lead responsibility for specified
51	coordination with respect to the development of a plan for
52	the staffing and medical management of pediatric special
53	needs shelters; requiring such plans to conform to the
54	local comprehensive emergency management plan; requiring
55	county governments to assist the Department of Health with
56	nonmedical staffing and operation of special needs
57	shelters; requiring county health departments and
58	emergency management agencies to coordinate such efforts
59	to ensure appropriate staffing; providing that the
60	appropriate county health department, Children's Medical
61	Services office, and local emergency management agency
62	shall jointly determine the responsibility for medical
63	supervision in a special needs shelter; requiring the
64	local health department and emergency management agency to
65	coordinate efforts to ensure appropriate designation,
66	operation, and closure of special needs shelters;
67	requiring the Secretary of Elderly Affairs to convene
68	multiagency special needs shelter discharge planning teams
69	to assist local areas that are severely impacted by a
70	natural or manmade disaster that requires the use of
71	special needs shelters; providing duties and
72	responsibilities of such discharge planning teams;
73	providing for the inclusion of specified state agency
74	representatives on each discharge planning team; revising
75	provisions relating to reimbursement of health care
76	practitioners; providing for eligibility of specified
77	health care facilities for reimbursement when a
78	multiagency special needs shelter discharge planning team
79	discharges persons with special needs to such receiving
80	facilities; providing procedures and requirements with
81	respect to such reimbursement; requiring the department to
82	specify by rule expenses that are reimbursable and the
83	rate of reimbursement for services; revising provisions
84	which prescribe means of and procedures for reimbursement;
85	disallowing specified reimbursements; revising provisions
86	with respect to the organization, role, duties, and
87	composition of the special needs shelter interagency
88	committee; requiring the department to adopt specified
89	rules with respect to special needs shelters; amending ss.
90	400.492, 400.497, 400.506, 400.610, and 400.934, F.S.;
91	revising requirements with respect to the comprehensive
92	emergency management plans of home health agencies, nurse
93	registries, and hospices, and providing such requirements
94	with respect to home medical equipment providers, to
95	include the means by which continuing services will be
96	provided to patients who evacuate to special needs
97	shelters; authorizing the establishment of links to local
98	emergency operations centers for specified purposes;
99	revising requirements of a county health department with
100	respect to review of a comprehensive emergency management
101	plan submitted by a home health agency, nurse registry, or
102	hospice; providing requirements upon failure to submit a
103	plan or requested information to the department; providing
104	for imposition of a fine; revising requirements of the
105	Department of Health with respect to review of the plan of
106	a home health agency or hospice that operates in more than
107	one county; providing that the preparation and maintenance
108	of a comprehensive emergency management plan by a home
109	medical equipment provider is a requirement for licensure
110	and must meet minimum criteria established by the Agency
111	for Health Care Administration; providing plan
112	requirements; providing that the plan is subject to review
113	and approval by the county health department; requiring
114	each home medical equipment provider to maintain a current
115	prioritized list of patients who need continued services
116	during an emergency; amending s. 400.925, F.S.; defining
117	"life-supporting or life-sustaining equipment" for
118	purposes of pt. X of ch. 400, F.S., relating to home
119	medical equipment providers; amending s. 400.935, F.S.;
120	requiring the Agency for Health Care Administration to
121	adopt rules with respect to the comprehensive emergency
122	management plan prepared by a home medical equipment
123	services provider; amending s. 408.831, F.S.; providing
124	that entities regulated or licensed by the Agency for
125	Health Care Administration may exceed their licensed
126	capacity to act as a receiving facility under specified
127	circumstances; providing requirements while such entities
128	are in an overcapacity status; providing for issuance of
129	an inactive license to such licensees under specified
130	conditions; providing requirements and procedures with
131	respect to the issuance and reactivation of an inactive
132	license; providing fees; requiring certain health
133	insurance entities to waive time restrictions on refilling
134	prescriptions for medication during specified emergency
135	conditions; providing legislative findings with respect to
136	the equipping of all designated public special needs
137	hurricane evacuation shelters with permanent emergency
138	power generating capacity by a specified date; requiring
139	the Department of Community Affairs to work with local
140	communities to ensure a sufficient number of public
141	special needs shelters designated to meet anticipated
142	demand; specifying the percentage of local match for such
143	projects; providing an appropriation to the Department of
144	Community Affairs to establish a competitive award
145	process; specifying a limit with respect to administration
146	of the funding; providing legislative findings with
147	respect to retrofitting public hurricane evacuation
148	shelters; providing criteria for the retrofitting of a
149	public hurricane evacuation shelter; providing an
150	appropriation to the Department of Community Affairs to
151	establish a competitive award process; specifying a limit
152	with respect to administration of the funding; providing
153	an appropriation to implement the provisions of emergency
154	management plan reviews for home health agencies and nurse
155	registry, hospice, and home medical equipment providers;
156	providing an effective date.
157
158	Be It Enacted by the Legislature of the State of Florida:
159
160	Section 1.  Section 252.355, Florida Statutes, is amended
161	to read:
162	252.355  Registry of persons with special needs; notice.--
163	(1)  In order to meet the special needs of persons who
164	would need assistance during evacuations and sheltering because
165	of physical, mental, cognitive impairment, or sensory
166	disabilities, each local emergency management agency in the
167	state shall maintain a registry of persons with special needs
168	located within the jurisdiction of the local agency. The
169	registration shall identify those persons in need of assistance
170	and plan for resource allocation to meet those identified needs.
171	To assist the local emergency management agency in identifying
172	such persons, home health agencies, hospices, nurse registries,
173	home medical equipment providers, the Department of Children and
174	Family Services, the Department of Health, the Agency for Health
175	Care Administration, the Department of Education, the Agency for
176	Persons with Disabilities, Department of Labor and Employment
177	Security, and the Department of Elderly Affairs shall provide
178	registration information to all of their special needs clients
179	and to all people with special needs who receive services
180	incoming clients as a part of the intake process. The registry
181	shall be updated annually. The registration program shall give
182	persons with special needs the option of preauthorizing
183	emergency response personnel to enter their homes during search
184	and rescue operations if necessary to assure their safety and
185	welfare following disasters.
186	(2)  The Department of Community Affairs shall be the
187	designated lead agency responsible for community education and
188	outreach to the general public, including special needs clients,
189	regarding registration and special needs shelters and general
190	information regarding shelter stays.
191	(3)  A person with special needs shall be allowed to bring
192	his or her service animal into a special needs shelter in
193	accordance with s. 413.08.
194	(4)(2)  On or before May 1 of each year each electric
195	utility in the state shall annually notify residential customers
196	in its service area of the availability of the registration
197	program available through their local emergency management
198	agency with either:
199	(a)  An initial notification upon the activation of new
200	residential service with the electric utility followed by one
201	annual notification between January 1 and May 31; or
202	(b)  Two separate annual notifications between January 1
203	and May 31.
204
205	The notification required under this subsection may be made by
206	any available means, including, but not limited to, written,
207	electronic, or verbal notification, and may be made concurrently
208	with any other notification to residential customers required by
209	law or rule.
210	(5)(3)  All records, data, information, correspondence, and
211	communications relating to the registration of persons with
212	special needs as provided in subsection (1) are confidential and
213	exempt from the provisions of s. 119.07(1), except that such
214	information shall be available to other emergency response
215	agencies, as determined by the local emergency management
216	director. Local law enforcement agencies shall be provided
217	complete shelter roster information upon request.
218	(6)(4)  All appropriate agencies and community-based
219	service providers, including home health care providers,
220	hospices, nurse registries, and home medical equipment
221	providers, shall assist emergency management agencies by
222	collecting registration information for persons with special
223	needs as part of program intake processes, establishing programs
224	to increase the awareness of the registration process, and
225	educating clients about the procedures that may be necessary for
226	their safety during disasters. Clients of state or federally
227	funded service programs with physical, mental, cognitive
228	impairment, or sensory disabilities who need assistance in
229	evacuating, or when in shelters, must register as persons with
230	special needs.
231	Section 2.  Section 252.3568, Florida Statutes, is created
232	to read:
233	252.3568  Emergency sheltering of persons with pets.--In
234	accordance with the provisions of s. 252.35, the division shall
235	address strategies for the evacuation of persons with pets in
236	the shelter component of the state comprehensive emergency
237	management plan and shall include the requirement for similar
238	strategies in its standards and requirements for local
239	comprehensive emergency management plans. The Department of
240	Agriculture and Consumer Services shall assist the division in
241	determining strategies regarding this activity.
242	Section 3.  Section 252.357, Florida Statutes, is created
243	to read:
244	252.357  Monitoring of nursing homes and assisted living
245	facilities during disaster.--The Florida Comprehensive Emergency
246	Management Plan shall permit the Agency for Health Care
247	Administration, working from the agency's offices or in the
248	Emergency Operations Center, ESF-8, to make initial contact with
249	each nursing home and assisted living facility in the disaster
250	area. The agency, by July 15, 2006, and annually thereafter,
251	shall publish on the Internet an emergency telephone number that
252	may be used by nursing homes and assisted living facilities to
253	contact the agency on a schedule established by the agency to
254	report requests for assistance. The agency may also provide the
255	telephone number to each facility when it makes the initial
256	facility call.
257	Section 4.  Subsection (2) and paragraphs (a) and (b) of
258	subsection (4) of section 252.385, Florida Statutes, are amended
259	to read:
260	252.385  Public shelter space.--
261	(2)(a)  The division shall administer a program to survey
262	existing schools, universities, community colleges, and other
263	state-owned, municipally owned, and county-owned public
264	buildings and any private facility that the owner, in writing,
265	agrees to provide for use as a public hurricane evacuation
266	shelter to identify those that are appropriately designed and
267	located to serve as such shelters. The owners of the facilities
268	must be given the opportunity to participate in the surveys. The
269	state university boards of trustees Board of Regents, district
270	school boards, community college boards of trustees, and the
271	Department of Education are responsible for coordinating and
272	implementing the survey of public schools, universities, and
273	community colleges with the division or the local emergency
274	management agency.
275	(b)  By January 31 of each even-numbered year, the division
276	shall prepare and submit a statewide emergency shelter plan to
277	the Governor and the Cabinet for approval, subject to the
278	requirements for approval provided in s. 1013.37(2). The plan
279	shall identify the general location and square footage of
280	special needs shelters, by regional planning council region,
281	during the next 5 years. The plan shall also include information
282	on the availability of shelters that accept pets. The Department
283	of Health shall assist the division in determining the estimated
284	need for special needs shelter space and the adequacy of
285	facilities to meet the needs of persons with special needs based
286	on information from the registries of persons with special needs
287	and other information.
288	(4)(a)  Public facilities, including schools, postsecondary
289	education facilities, and other facilities owned or leased by
290	the state or local governments, but excluding hospitals, hospice
291	care facilities, assisted living facilities, or nursing homes,
292	which are suitable for use as public hurricane evacuation
293	shelters shall be made available at the request of the local
294	emergency management agencies. The local emergency management
295	agency shall coordinate with these entities to ensure that
296	designated facilities are ready to activate prior to a specific
297	hurricane or disaster. Such agencies shall coordinate with the
298	appropriate school board, university, community college, or
299	local governing board when requesting the use of such facilities
300	as public hurricane evacuation shelters.
301	(b)  The Department of Management Services shall
302	incorporate provisions for the use of suitable leased public
303	facilities as public hurricane evacuation shelters into lease
304	agreements for state agencies. Suitable leased public facilities
305	include leased public facilities that are solely occupied by
306	state agencies and have at least 2,000 square feet of net floor
307	area in a single room or in a combination of rooms having a
308	minimum of 400 square feet in each room. The net square footage
309	of floor area shall must be determined by subtracting from the
310	gross square footage the square footage of spaces such as
311	mechanical and electrical rooms, storage rooms, open corridors,
312	restrooms, kitchens, science or computer laboratories, shop or
313	mechanical areas, administrative offices, records vaults, and
314	crawl spaces.
315	Section 5.  Section 381.0303, Florida Statutes, is amended
316	to read:
317	381.0303  Health practitioner recruitment for Special needs
318	shelters.--
319	(1)  PURPOSE.--The purpose of this section is to provide
320	for the operation and closure of special needs shelters and to
321	designate the Department of Health, through its county health
322	departments, as the lead agency for coordination of the
323	recruitment of health care practitioners, as defined in s.
324	456.001(4), to staff special needs shelters in times of
325	emergency or disaster and to provide resources to the department
326	to carry out this responsibility. However, nothing in this
327	section prohibits a county health department from entering into
328	an agreement with a local emergency management agency to assume
329	the lead responsibility for recruiting health care
330	practitioners.
331	(2)  SPECIAL NEEDS SHELTER PLAN; STAFFING; STATE AGENCY
332	ASSISTANCE AND STAFFING.--Provided funds have been appropriated
333	to support medical services disaster coordinator positions in
334	county health departments:,
335	(a)  The department shall assume lead responsibility for
336	the local coordination of local medical and health care
337	providers, the American Red Cross, and other interested parties
338	in developing a plan for the staffing and medical management of
339	special needs shelters. The local Children's Medical Services
340	offices shall assume lead responsibility for the coordination of
341	local medical and health care providers, the American Red Cross,
342	and other interested parties in developing a plan for the
343	staffing and medical management of pediatric special needs
344	shelters. Plans shall conform to The plan shall be in
345	conformance with the local comprehensive emergency management
346	plan.
347	(b)(a)  County health departments shall, in conjunction
348	with the local emergency management agencies, have the lead
349	responsibility for coordination of the recruitment of health
350	care practitioners to staff local special needs shelters. County
351	health departments shall assign their employees to work in
352	special needs shelters when those employees are needed to
353	protect the health and safety of persons with special needs of
354	patients. County governments shall assist the department with
355	nonmedical staffing and the operation of special needs shelters.
356	The local health department and emergency management agency
357	shall coordinate these efforts to ensure appropriate staffing in
358	special needs shelters.
359	(c)(b)  The appropriate county health department,
360	Children's Medical Services office, and local emergency
361	management agency shall jointly decide determine who has
362	responsibility for medical supervision in each a special needs
363	shelter.
364	(d)(c)  Local emergency management agencies shall be
365	responsible for the designation and operation of special needs
366	shelters during times of emergency or disaster and the closure
367	of the facilities following an emergency or disaster. The local
368	health department and emergency management agency shall
369	coordinate these efforts to ensure the appropriate designation,
370	operation, and closure of special needs shelters. County health
371	departments shall assist the local emergency management agency
372	with regard to the management of medical services in special
373	needs shelters.
374	(e)  The Secretary of Elderly Affairs, or his or her
375	designee, shall convene, at any time that he or she deems
376	appropriate and necessary, a multiagency special needs shelter
377	discharge planning team or teams to assist local areas that are
378	severely impacted by a natural or manmade disaster that requires
379	the use of special needs shelters. Multiagency special needs
380	shelter discharge planning teams shall provide assistance to
381	local emergency management agencies with the continued operation
382	or closure of the shelters, as well as with the discharge of
383	special needs clients to alternate facilities if necessary.
384	Local emergency management agencies may request the assistance
385	of a multiagency special needs shelter discharge planning team
386	by alerting statewide emergency management officials of the
387	necessity for additional assistance in their area. The Secretary
388	of Elderly Affairs is encouraged to proactively work with other
389	state agencies prior to any natural disasters for which warnings
390	are provided to ensure that multiagency special needs shelter
391	discharge planning teams are ready to assemble and deploy
392	rapidly upon a determination by state emergency management
393	officials that a disaster area requires additional assistance.
394	The Secretary of Elderly Affairs may call upon any state agency
395	or office to provide staff to assist a multiagency special needs
396	shelter discharge planning team or teams. Unless the secretary
397	determines that the nature or circumstances surrounding the
398	disaster do not warrant participation from a particular agency's
399	staff, each multiagency special needs shelter discharge planning
400	team shall include at least one representative from each of the
401	following state agencies:
402	1.  Department of Elderly Affairs.
403	2.  Department of Health.
404	3.  Department of Children and Family Services.
405	4.  Department of Veterans' Affairs.
406	5.  Department of Community Affairs.
407	6.  Agency for Health Care Administration.
408	7.  Agency for Persons with Disabilities.
409	(3)  REIMBURSEMENT TO HEALTH CARE PRACTITIONERS AND
410	FACILITIES.--
411	(a)  The department of Health shall upon request reimburse,
412	in accordance with paragraph (b): subject to the availability of
413	funds for this purpose,
414	1.  Health care practitioners, as defined in s. 456.001,
415	provided the practitioner is not providing care to a patient
416	under an existing contract, and emergency medical technicians
417	and paramedics licensed under pursuant to chapter 401 for
418	medical care provided at the request of the department in
419	special needs shelters or at other locations during times of
420	emergency or a declared major disaster. Reimbursement for health
421	care practitioners, except for physicians licensed under
422	pursuant to chapter 458 or chapter 459, shall be based on the
423	average hourly rate that such practitioners were paid according
424	to the most recent survey of Florida hospitals conducted by the
425	Florida Hospital Association or other nationally or state
426	recognized data source. Reimbursement shall be requested on
427	forms prepared by the Department of Health.
428	2.  Health care facilities, such as hospitals, nursing
429	homes, assisted living facilities, and community residential
430	homes, if, upon closure of a special needs shelter, a
431	multiagency special needs shelter discharge planning team
432	determines that it is necessary to discharge persons with
433	special needs to other health care facilities. The receiving
434	facilities shall be eligible for reimbursement for services
435	provided to the individuals for up to 90 days. A facility must
436	show proof of a written request from a representative of an
437	agency serving on the multiagency special needs shelter
438	discharge planning team that the individual for whom the
439	facility is seeking reimbursement for services rendered was
440	referred to that facility from a special needs shelter. The
441	department shall specify by rule which expenses are reimbursable
442	and the rate of reimbursement for each service.
443	(b)  Reimbursement is subject to the availability of
444	federal funds and shall be requested on forms prepared by the
445	department. If a Presidential Disaster Declaration has been
446	issued made, and the Federal Government makes funds available,
447	the department shall request federal use such funds for
448	reimbursement of eligible expenditures. In other situations, or
449	if federal funds do not fully compensate the department for
450	reimbursement made pursuant to this section, the department
451	shall process a budget amendment to obtain reimbursement from
452	unobligated, unappropriated moneys in the General Revenue Fund.
453	The department shall not provide reimbursement to facilities
454	under this subsection for services provided to a person with
455	special needs if, during the period of time in which the
456	services were provided, the individual was enrolled in another
457	state-funded program, such as Medicaid or another similar
458	program, was covered under a policy of health insurance as
459	defined in s. 624.603, or was a member of a health maintenance
460	organization or prepaid health clinic as defined in chapter 641,
461	which would otherwise pay for the same services. Travel expense
462	and per diem costs shall be reimbursed pursuant to s. 112.061.
463	(4)  HEALTH CARE PRACTITIONER REGISTRY.--The department may
464	use the registries established in ss. 401.273 and 456.38 when
465	health care practitioners are needed to staff special needs
466	shelters or to assist with other disaster-related activities
467	staff disaster medical assistance teams.
468	(5)  SPECIAL NEEDS SHELTER INTERAGENCY COMMITTEE.--The
469	Secretary Department of Health may establish a special needs
470	shelter interagency committee and serve as or appoint a designee
471	to serve as the committee's chair. The department shall provide
472	any necessary staff and resources to support the committee in
473	the performance of its duties, to be chaired and staffed by the
474	department. The committee shall address and resolve problems
475	related to special needs shelters not addressed in the state
476	comprehensive emergency medical plan and shall consult on serve
477	as an oversight committee to monitor the planning and operation
478	of special needs shelters.
479	(a)  The committee shall may:
480	1.  Develop, and negotiate, and regularly review any
481	necessary interagency agreements.
482	2.  Undertake other such activities as the department deems
483	necessary to facilitate the implementation of this section.
484	3.  Submit recommendations to the Legislature as necessary.
485	(b)  The special needs shelter interagency committee shall
486	be composed of representatives of emergency management, health,
487	medical, and social services organizations. Membership shall
488	include, but shall not be limited to, representatives of the
489	Departments of Health, Community Affairs, Children and Family
490	Services, Elderly Affairs, Labor and Employment Security, and
491	Education; the Agency for Health Care Administration; the
492	Florida Medical Association; the Florida Osteopathic Medical
493	Association; Associated Home Health Industries of Florida, Inc.;
494	the Florida Nurses Association; the Florida Health Care
495	Association; the Florida Assisted Living Affiliation
496	Association; the Florida Hospital Association; the Florida
497	Statutory Teaching Hospital Council; the Florida Association of
498	Homes for the Aging; the Florida Emergency Preparedness
499	Association; the American Red Cross; Florida Hospices and
500	Palliative Care, Inc.; the Association of Community Hospitals
501	and Health Systems; the Florida Association of Health
502	Maintenance Organizations; the Florida League of Health Systems;
503	Private Care Association; and the Salvation Army; the Florida
504	Association of Aging Services Providers; AARP; and the Florida
505	Renal Coalition.
506	(c)  Meetings of the committee shall be held in
507	Tallahassee, and members of the committee shall serve at the
508	expense of the agencies or organizations they represent. The
509	committee shall make every effort to use teleconference or video
510	conference capabilities in order to ensure statewide input and
511	participation.
512	(6)  RULES.--The department has the authority to adopt
513	rules necessary to implement this section. Rules shall may
514	include:
515	(a)  The a definition of a "person with special needs",
516	including eligibility criteria for individuals with physical,
517	mental, cognitive impairment, or sensory disabilities and the
518	services a person with special needs can expect to receive in a
519	special needs shelter patient, specify physician reimbursement,
520	and designate which county health departments will have
521	responsibility for implementation of subsections (2) and (3).
522	(b)  The process for special needs shelter health care
523	practitioners and facility reimbursement for services provided
524	in a disaster.
525	(c)  Guidelines for special needs shelter staffing levels
526	to provide services.
527	(d)  The definition of and standards for special needs
528	shelter supplies and equipment, including durable medical
529	equipment.
530	(e)  Standards for the special needs shelter registration
531	process, including guidelines for addressing the needs of
532	unregistered persons in need of a special needs shelter.
533	(f)  Standards for addressing the needs of families where
534	only one dependent is eligible for admission to a special needs
535	shelter and the needs of adults with special needs who are
536	caregivers for individuals without special needs.
537	(g)  The requirement of the county health departments to
538	seek the participation of hospitals, nursing homes, assisted
539	living facilities, home health agencies, hospice providers,
540	nurse registries, home medical equipment providers, dialysis
541	centers, and other health and medical emergency preparedness
542	stakeholders in pre-event planning activities.
543	(7)  REVIEW OF EMERGENCY MANAGEMENT PLANS.--The submission
544	of emergency management plans to county health departments by
545	home health agencies, pursuant to s. 400.497(8)(c) and (d) and
546	by nurse registries, pursuant to s. 400.506(16)(e) and by
547	hospice programs, pursuant to s. 400.610(1)(b) and home medical
548	equipment providers is conditional upon the receipt of an
549	appropriation by the department to establish medical services
550	disaster coordinator positions in county health departments
551	unless the secretary of the department and a local county
552	commission jointly determine to require such plans to be
553	submitted based on a determination that there is a special need
554	to protect public health in the local area during an emergency.
555	Section 6.  Section 400.492, Florida Statutes, is amended
556	to read:
557	400.492  Provision of services during an emergency.--Each
558	home health agency shall prepare and maintain a comprehensive
559	emergency management plan that is consistent with the standards
560	adopted by national or state accreditation organizations and
561	consistent with the local special needs plan. The plan shall be
562	updated annually and shall provide for continuing home health
563	services during an emergency that interrupts patient care or
564	services in the patient's home. The plan shall include the means
565	by which the home health agency will continue to provide staff
566	to perform the same type and quantity of services to their
567	patients who evacuate to special needs shelters that were being
568	provided to those patients prior to evacuation. The plan shall
569	describe how the home health agency establishes and maintains an
570	effective response to emergencies and disasters, including:
571	notifying staff when emergency response measures are initiated;
572	providing for communication between staff members, county health
573	departments, and local emergency management agencies, including
574	a backup system; identifying resources necessary to continue
575	essential care or services or referrals to other organizations
576	subject to written agreement; and prioritizing and contacting
577	patients who need continued care or services.
578	(1)  Each patient record for patients who are listed in the
579	registry established pursuant to s. 252.355 shall include a
580	description of how care or services will be continued in the
581	event of an emergency or disaster. The home health agency shall
582	discuss the emergency provisions with the patient and the
583	patient's caregivers, including where and how the patient is to
584	evacuate, procedures for notifying the home health agency in the
585	event that the patient evacuates to a location other than the
586	shelter identified in the patient record, and a list of
587	medications and equipment which must either accompany the
588	patient or will be needed by the patient in the event of an
589	evacuation.
590	(2)  Each home health agency shall maintain a current
591	prioritized list of patients who need continued services during
592	an emergency. The list shall indicate how services shall be
593	continued in the event of an emergency or disaster for each
594	patient and if the patient is to be transported to a special
595	needs shelter, and shall indicate if the patient is receiving
596	skilled nursing services and the patient's medication and
597	equipment needs. The list shall be furnished to county health
598	departments and to local emergency management agencies, upon
599	request.
600	(3)  Home health agencies shall not be required to continue
601	to provide care to patients in emergency situations that are
602	beyond their control and that make it impossible to provide
603	services, such as when roads are impassable or when patients do
604	not go to the location specified in their patient records. Home
605	health agencies may establish links to local emergency
606	operations centers to determine a mechanism to approach specific
607	areas within a disaster area in order for the agency to reach
608	its clients. Home health agencies shall demonstrate a good faith
609	effort to comply with the requirements of this subsection by
610	documenting attempts of staff to follow procedures as outlined
611	in the home health agency's comprehensive emergency management
612	plan, and by the patient's record, which support a finding that
613	attempts were made to provide continuing care for those patients
614	who have been identified as needing care by the home health
615	agency and who are registered under s. 252.355 in the event of
616	an emergency or disaster under subsection (1).
617	(4)  Notwithstanding the provisions of s. 400.464(2) or any
618	other provision of law to the contrary, a home health agency may
619	provide services in a special needs shelter located in any
620	county.
621	Section 7.  Paragraphs (c) and (d) of subsection (8) of
622	section 400.497, Florida Statutes, are amended to read:
623	400.497  Rules establishing minimum standards.--The agency
624	shall adopt, publish, and enforce rules to implement this part,
625	including, as applicable, ss. 400.506 and 400.509, which must
626	provide reasonable and fair minimum standards relating to:
627	(8)  Preparation of a comprehensive emergency management
628	plan pursuant to s. 400.492.
629	(c)  The plan is subject to review and approval by the
630	county health department. During its review, the county health
631	department shall contact state and local health and medical
632	stakeholders during its review when necessary. ensure that the
633	following agencies, at a minimum, are given the opportunity to
634	review the plan:
635	1.  The local emergency management agency.
636	2.  The Agency for Health Care Administration.
637	3.  The local chapter of the American Red Cross or other
638	lead sheltering agency.
639	4.  The district office of the Department of Children and
640	Family Services.
641
642	The county health department shall complete its review to ensure
643	that the plan is in accordance with the criteria set forth in
644	the rules of the Agency for Health Care Administration within 90
645	60 days after receipt of the plan and shall either approve the
646	plan or advise the home health agency of necessary revisions. If
647	the home health agency fails to submit a plan or fails to submit
648	the requested information or revisions to the county health
649	department within 30 days after written notification from the
650	county health department, the county health department shall
651	notify the Agency for Health Care Administration. The agency
652	shall notify the home health agency that such failure
653	constitutes a deficiency, subject to a fine of $5,000 per
654	occurrence. If the plan is not submitted, information is not
655	provided, or revisions are not made as requested, the agency may
656	impose the fine.
657	(d)  For any home health agency that operates in more than
658	one county, the Department of Health shall review the plan,
659	after consulting with state and local health and medical
660	stakeholders, when necessary all of the county health
661	departments, the agency, and all the local chapters of the
662	American Red Cross or other lead sheltering agencies in the
663	areas of operation for that particular home health agency. The
664	department of Health shall complete its review within 90 days
665	after receipt of the plan and shall either approve the plan or
666	advise the home health agency of necessary revisions. The
667	department of Health shall make every effort to avoid imposing
668	differing requirements on a home health agency that operates in
669	more than one county as a result of differing or conflicting
670	comprehensive plan requirements of the based on differences
671	between counties in which on the home health agency operates.
672	Section 8.  Subsection (16) of section 400.506, Florida
673	Statutes, is amended to read:
674	400.506  Licensure of nurse registries; requirements;
675	penalties.--
676	(16)  Each nurse registry shall prepare and maintain a
677	comprehensive emergency management plan that is consistent with
678	the criteria in this subsection and with the local special needs
679	plan. The plan shall be updated annually. The plan shall include
680	the means by which the nurse registry will continue to perform
681	the same type and quantity of services to their patients who
682	evacuate to special needs shelters that were being provided to
683	those patients prior to evacuation. The plan shall specify how
684	the nurse registry shall facilitate the provision of continuous
685	care by persons referred for contract to persons who are
686	registered pursuant to s. 252.355 during an emergency that
687	interrupts the provision of care or services in private
688	residencies. Nurse registries may establish links to local
689	emergency operations centers to determine a mechanism to
690	approach specific areas within a disaster area in order for a
691	provider to reach its clients. Nurse registries shall
692	demonstrate a good faith effort to comply with the requirements
693	of this subsection by documenting attempts of staff to follow
694	procedures as outlined in the nurse registry's comprehensive
695	emergency management plan which support a finding that attempts
696	were made to provide continuing care for those patients who have
697	been identified as needing care by the nurse registry and who
698	are registered under s. 252.355 in the event of an emergency.
699	(a)  All persons referred for contract who care for persons
700	registered pursuant to s. 252.355 must include in the patient
701	record a description of how care will be continued during a
702	disaster or emergency that interrupts the provision of care in
703	the patient's home. It shall be the responsibility of the person
704	referred for contract to ensure that continuous care is
705	provided.
706	(b)  Each nurse registry shall maintain a current
707	prioritized list of patients in private residences who are
708	registered pursuant to s. 252.355 and are under the care of
709	persons referred for contract and who need continued services
710	during an emergency. This list shall indicate, for each patient,
711	if the client is to be transported to a special needs shelter
712	and if the patient is receiving skilled nursing services. Nurse
713	registries shall make this list available to county health
714	departments and to local emergency management agencies upon
715	request.
716	(c)  Each person referred for contract who is caring for a
717	patient who is registered pursuant to s. 252.355 shall provide a
718	list of the patient's medication and equipment needs to the
719	nurse registry. Each person referred for contract shall make
720	this information available to county health departments and to
721	local emergency management agencies upon request.
722	(d)  Each person referred for contract shall not be
723	required to continue to provide care to patients in emergency
724	situations that are beyond the person's control and that make it
725	impossible to provide services, such as when roads are
726	impassable or when patients do not go to the location specified
727	in their patient records.
728	(e)  The comprehensive emergency management plan required
729	by this subsection is subject to review and approval by the
730	county health department. During its review, the county health
731	department shall contact state and local health and medical
732	stakeholders, when necessary ensure that, at a minimum, the
733	local emergency management agency, the Agency for Health Care
734	Administration, and the local chapter of the American Red Cross
735	or other lead sheltering agency are given the opportunity to
736	review the plan. The county health department shall complete its
737	review to ensure that the plan is in accordance with the
738	criteria set forth in the rules of the Agency for Health Care
739	Administration within 90 60 days after receipt of the plan and
740	shall either approve the plan or advise the nurse registry of
741	necessary revisions. If a nurse registry fails to submit a plan
742	or fails to submit requested information or revisions to the
743	county health department within 30 days after written
744	notification from the county health department, the county
745	health department shall notify the Agency for Health Care
746	Administration. The agency shall notify the nurse registry that
747	such failure constitutes a deficiency, subject to a fine of
748	$5,000 per occurrence. If the plan is not submitted, information
749	is not provided, or revisions are not made as requested, the
750	agency may impose the fine.
751	(f)  The Agency for Health Care Administration shall adopt
752	rules establishing minimum criteria for the comprehensive
753	emergency management plan and plan updates required by this
754	subsection, with the concurrence of the Department of Health and
755	in consultation with the Department of Community Affairs.
756	Section 9.  Paragraph (b) of subsection (1) of section
757	400.610, Florida Statutes, is amended to read:
758	400.610  Administration and management of a hospice.--
759	(1)  A hospice shall have a clearly defined organized
760	governing body, consisting of a minimum of seven persons who are
761	representative of the general population of the community
762	served. The governing body shall have autonomous authority and
763	responsibility for the operation of the hospice and shall meet
764	at least quarterly. The governing body shall:
765	(b)1.  Prepare and maintain a comprehensive emergency
766	management plan that provides for continuing hospice services in
767	the event of an emergency that is consistent with local special
768	needs plans. The plan shall include provisions for ensuring
769	continuing care to hospice patients who go to special needs
770	shelters. The plan shall include the means by which the hospice
771	provider will continue to provide staff to perform the same type
772	and quantity of services to their patients who evacuate to
773	special needs shelters that were being provided to those
774	patients prior to evacuation. The plan is subject to review and
775	approval by the county health department, except as provided in
776	subparagraph 2. During its review, the county health department
777	shall contact state and local health and medical stakeholders,
778	when necessary ensure that the department, the agency, and the
779	local chapter of the American Red Cross or other lead sheltering
780	agency have an opportunity to review and comment on the plan.
781	The county health department shall complete its review to ensure
782	that the plan is in accordance with the criteria set forth in
783	the rules of the Department of Elderly Affairs within 90 60 days
784	after receipt of the plan and shall either approve the plan or
785	advise the hospice of necessary revisions. Hospice providers may
786	establish links to local emergency operations centers to
787	determine a mechanism to approach specific areas within a
788	disaster area in order for the provider to reach its clients. A
789	hospice shall demonstrate a good faith effort to comply with the
790	requirements of this paragraph by documenting attempts of staff
791	to follow procedures as outlined in the hospice's comprehensive
792	emergency management plan and to provide continuing care for
793	those hospice clients who have been identified as needing
794	alternative caregiver services in the event of an emergency.
795	2.  For any hospice that operates in more than one county,
796	the Department of Health during its review shall contact state
797	and local health and medical stakeholders, when necessary review
798	the plan, after consulting with all of the county health
799	departments, the agency, and all the local chapters of the
800	American Red Cross or other lead sheltering agency in the areas
801	of operation for that particular hospice. The Department of
802	Health shall complete its review to ensure that the plan is in
803	accordance with the criteria set forth in the rules of the
804	Department of Elderly Affairs within 90 days after receipt of
805	the plan and shall either approve the plan or advise the hospice
806	of necessary revisions. The Department of Health shall make
807	every effort to avoid imposing on the hospice differing
808	requirements on a hospice that operates in more than one county
809	as a result of differing or conflicting comprehensive plan
810	requirements of the based on differences between counties in
811	which the hospice operates.
812	Section 10.  Subsections (13) through (16) of section
813	400.925, Florida Statutes, are renumbered as subsections (14)
814	through (17), respectively, and a new subsection (13) is added
815	to that section to read:
816	400.925  Definitions.--As used in this part, the term:
817	(13)  "Life-supporting or life-sustaining equipment" means
818	a device that is essential to, or that yields information that
819	is essential to, the restoration or continuation of a bodily
820	function important to the continuation of human life. Life-
821	supporting or life-sustaining equipment includes apnea monitors,
822	enteral feeding pumps, infusion pumps, portable home dialysis
823	equipment, and ventilator equipment and supplies for all related
824	equipment, including oxygen equipment and related respiratory
825	equipment.
826	Section 11.  Subsections (20), (21), and (22) are added to
827	section 400.934, Florida Statutes, to read:
828	400.934  Minimum standards.--As a requirement of licensure,
829	home medical equipment providers shall:
830	(20)(a)  Prepare and maintain a comprehensive emergency
831	management plan that meets minimum criteria established by the
832	agency in rule under s. 400.935. The plan shall be updated
833	annually and shall provide for continuing home medical equipment
834	services for life-supporting or life-sustaining equipment, as
835	defined in 400.925, during an emergency that interrupts home
836	medical equipment services in a patient's home. The plan shall
837	include:
838	1.  The means by which the home medical equipment provider
839	will continue to provide equipment to perform the same type and
840	quantity of services to its patients who evacuate to special
841	needs shelters that were being provided to those patients prior
842	to evacuation.
843	2.  The means by which the home medical equipment provider
844	establishes and maintains an effective response to emergencies
845	and disasters, including plans for:
846	a.  Notification of staff when emergency response measures
847	are initiated.
848	b.  Communication between staff members, county health
849	departments, and local emergency management agencies, which
850	shall include provisions for a backup communications system.
851	c.  Identification of resources necessary to continue
852	essential care or services or referrals to other organizations
853	subject to written agreement.
854	d.  Contacting and prioritizing patients in need of
855	continued medical equipment services and supplies.
856	(b)  The plan is subject to review and approval by the
857	county health department. During its review, the county health
858	department shall contact state and local health and medical
859	stakeholders, when necessary. The county health department shall
860	complete its review to ensure that the plan is in accordance
861	with the criteria set forth in the rules of the Agency for
862	Health Care Administration within 90 days after receipt of the
863	plan. If a home medical equipment provider fails to submit a
864	plan or fails to submit requested information or revisions to
865	the county health department within 30 days after written
866	notification from the county health department, the county
867	health department shall notify the Agency for Health Care
868	Administration. The agency shall notify the home medical
869	equipment provider that such failure constitutes a deficiency,
870	subject to a fine of $5,000 per occurrence. If the plan is not
871	submitted, information is not provided, or revisions are not
872	made as requested, the agency may impose the fine.
873	(21)  Each home medical equipment provider shall maintain a
874	current prioritized list of patients who need continued services
875	during an emergency. The list shall indicate the means by which
876	services shall be continued for each patient in the event of an
877	emergency or disaster, whether the patient is to be transported
878	to a special needs shelter, and whether the patient has life-
879	supporting or life-sustaining equipment, including the specific
880	type of equipment and related supplies. The list shall be
881	furnished to county health departments and local emergency
882	management agencies, upon request.
883	(22)  Home medical equipment providers may establish links
884	to local emergency operations centers to determine a mechanism
885	to approach specific areas within a disaster area in order for
886	the provider to reach its patients.
887	Section 12.  Subsection (11) is added to section 400.935,
888	Florida Statutes, to read:
889	400.935  Rules establishing minimum standards.--The agency
890	shall adopt, publish, and enforce rules to implement this part,
891	which must provide reasonable and fair minimum standards
892	relating to:
893	(11)  Preparation of the comprehensive emergency management
894	plan under s. 400.934 and the establishment of minimum criteria
895	for the plan, including the maintenance of patient equipment and
896	supply lists that can accompany patients who are transported
897	from their homes. Such rules shall be formulated in consultation
898	with the Department of Health and the Department of Community
899	Affairs.
900	Section 13.  Section 408.831, Florida Statutes, is amended
901	to read:
902	408.831  Denial, suspension, or revocation of a license,
903	registration, certificate, or application.--
904	(1)  In addition to any other remedies provided by law, the
905	agency may deny each application or suspend or revoke each
906	license, registration, or certificate of entities regulated or
907	licensed by it:
908	(a)  If the applicant, licensee, registrant, or
909	certificateholder, or, in the case of a corporation,
910	partnership, or other business entity, if any officer, director,
911	agent, or managing employee of that business entity or any
912	affiliated person, partner, or shareholder having an ownership
913	interest equal to 5 percent or greater in that business entity,
914	has failed to pay all outstanding fines, liens, or overpayments
915	assessed by final order of the agency or final order of the
916	Centers for Medicare and Medicaid Services, not subject to
917	further appeal, unless a repayment plan is approved by the
918	agency; or
919	(b)  For failure to comply with any repayment plan.
920	(2)  In reviewing any application requesting a change of
921	ownership or change of the licensee, registrant, or
922	certificateholder, the transferor shall, prior to agency
923	approval of the change, repay or make arrangements to repay any
924	amounts owed to the agency. Should the transferor fail to repay
925	or make arrangements to repay the amounts owed to the agency,
926	the issuance of a license, registration, or certificate to the
927	transferee shall be delayed until repayment or until
928	arrangements for repayment are made.
929	(3)  Entities subject to this section may exceed their
930	licensed capacity to act as a receiving facility in accordance
931	with an emergency operations plan for clients of evacuating
932	providers from a geographic area where an evacuation order has
933	been issued by a local authority having jurisdiction. While in
934	an overcapacity status, each provider must furnish or arrange
935	for appropriate care and services to all clients. In addition,
936	the agency may approve requests for overcapacity beyond 15 days,
937	which approvals may be based upon satisfactory justification and
938	need as provided by the receiving and sending facility.
939	(4)  An inactive license may be issued to a licensee
940	subject to this section when the provider is located in a
941	geographic area where a state of emergency was declared by the
942	Governor if the provider:
943	(a)  Suffered damage to the provider's operation during
944	that state of emergency.
945	(b)  Is currently licensed.
946	(c)  Does not have a provisional license.
947	(d)  Will be temporarily unable to provide services but is
948	reasonably expected to resume services within 12 months.
949
950	An inactive license may be issued for a period not to exceed 12
951	months but may be renewed by the agency for up to 12 additional
952	months upon demonstration to the agency of progress toward
953	reopening. A request by a licensee for an inactive license or to
954	extend the previously approved inactive period must be submitted
955	in writing to the agency, accompanied by written justification
956	for the inactive license which states the beginning and ending
957	dates of inactivity and includes a plan for the transfer of any
958	clients to other providers and appropriate licensure fees. Upon
959	agency approval, the licensee shall notify clients of any
960	necessary discharge or transfer as required by authorizing
961	statutes or applicable rules. The beginning of the inactive
962	licensure period shall be the date the provider ceases
963	operations. The end of the inactive period shall become the
964	licensee expiration date, and all licensure fees must be
965	current, paid in full, and may be prorated. Reactivation of an
966	inactive license requires the prior approval by the agency of a
967	renewal application, including payment of licensure fees and
968	agency inspections indicating compliance with all requirements
969	of this part and applicable rules and statutes.
970	(5)(3) This section provides standards of enforcement
971	applicable to all entities licensed or regulated by the Agency
972	for Health Care Administration. This section controls over any
973	conflicting provisions of chapters 39, 381, 383, 390, 391, 393,
974	394, 395, 400, 408, 468, 483, and 641 or rules adopted pursuant
975	to those chapters.
976	Section 14.  Emergency preparedness prescription medication
977	refills.--
978	(1)  All health insurers, managed care organizations, and
979	other entities licensed by the Office of Insurance Regulation
980	that provide prescription medication coverage as part of a
981	policy or contract shall waive time restrictions on prescription
982	medication refills, which includes suspension of electronic
983	"refill too soon" edits to pharmacies, to enable insureds or
984	subscribers to refill prescriptions in advance, as long as there
985	are authorized refills remaining, and shall authorize payment to
986	pharmacies for at least a 30-day supply of any prescription
987	medication, regardless of the date upon which the prescription
988	had most recently been filled by a pharmacist, when the
989	following conditions occur:
990	(a)  The person seeking the prescription medication refill
991	resides in a county that:
992	1.  Is under a hurricane warning issued by the National
993	Weather Service;
994	2.  Is declared to be under a state of emergency in an
995	executive order issued by the Governor; or
996	3.  Has activated its emergency operations center and its
997	emergency management plan.
998	(b)  The prescription medication refill is requested:
999	1.  Within 30 days of the date upon which the conditions
1000	set forth in paragraph (a) originated; or
1001	2.  Prior to the date upon which the conditions set forth
1002	in paragraph (a) are terminated by the issuing authority or no
1003	longer exist.
1004
1005	The time period for the waiver of prescription medication
1006	refills may be extended in 15-day or 30-day increments by
1007	emergency orders issued by the Office of Insurance Regulation.
1008	(2)  Nothing in this section excuses or exempts an insured
1009	or subscriber from compliance with all the other terms of the
1010	policy or contract providing prescription medication coverage.
1011	Section 15.  The Legislature finds that all designated
1012	public special needs hurricane evacuation shelters should be
1013	equipped with permanent emergency power generating capacity to
1014	provide the necessary equipment, heating, ventilation, and air-
1015	conditioning to meet the medical needs of patients by June 1,
1016	2007. The Department of Community Affairs shall work with local
1017	communities to ensure that there is a sufficient number of
1018	public special needs shelters designated to meet the anticipated
1019	demand based on best available data as determined by the
1020	department and the Department of Health. Local match for these
1021	projects shall be no less than 25 percent of project cost. There
1022	is hereby appropriated $21.5 million from the U.S. Contributions
1023	Trust Fund in fixed capital outlay to the Department of
1024	Community Affairs to establish a competitive award process to
1025	implement this section. No more than 5 percent of the funds
1026	provided under this section may be used by the department for
1027	administration of the funding.
1028	Section 16.  The Legislature finds that retrofitting public
1029	hurricane evacuation shelters is an efficient and economical
1030	method of accelerating the state and local efforts to reduce the
1031	shelter deficit. Criteria for the retrofitting of a public
1032	hurricane evacuation shelter shall include, but not be limited
1033	to, the project's ability to meet the structural and siting
1034	requirements of American Red Cross Standard ARC 4496,
1035	"Guidelines for Hurricane Evacuation Shelter Selection," once
1036	completed; the shelter needs for the local government, as well
1037	as the overall needs of the hurricane evacuation planning
1038	region; the cost-effectiveness of the project in terms of the
1039	number of public hurricane evacuation spaces; and the priority
1040	ranking of the proposed project in the applicable local
1041	mitigation strategy. There is hereby appropriated $9 million
1042	from the U.S. Contributions Trust Fund in fixed capital outlay
1043	to the Department of Community Affairs to establish a
1044	competitive award process to implement this section. No more
1045	than 5 percent of the funds provided under this section may be
1046	used by the department for administration of this funding.
1047	Section 17.  For the 2006-2007 fiscal year, the sums of
1048	$896,799 from recurring general revenue funds and $104,156 from
1049	nonrecurring general revenue funds are appropriated, and 20
1050	full-time equivalent positions are authorized at 872,644 salary
1051	rate, to implement the provisions of emergency management plan
1052	reviews for home health agencies and nurse registry, hospice,
1053	and home medical equipment providers.
1054	Section 18.  This act shall take effect July 1, 2006.

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